Changes in the diagnosis of depression among nursing professionals during the COVID-19 pandemic: A longitudinal study.

AIMS: To identify changes in mental health status among nursing professionals in a Brazilian municipality during the COVID-19 pandemic. DESIGN: An observational and longitudinal study. METHODS: Using the Patient Health Questionnaire-9, the presence of depressive symptoms was evaluated among 690 nursing professionals in the city of Pelotas, Brazil, at two moments: June/July 2020 and June/July 2021. RESULTS: 13.0% incidence of depressive symptoms was identified; as well as 12.2% remission; 24.1% persistence and 50.7% absence. Among the factors associated with the worst prognoses we can mention female gender, greater workload, feeling of overload, illness of family members or friends due to COVID-19 and use of psychotropic drugs CONCLUSIONS: There was significant mobility in the diagnosis of depression among the professionals studied during the period analysed, with incidence of new cases of significant depression and greater than the number of remissions. In addition to sociodemographic aspects, traumatic experiences and exposure to continuous overload were associated with persistence and incidence of new cases. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: With the advent of the COVID-19 pandemic, several studies have shown an increase in depressive symptoms among nursing professionals; however, understanding the long-term effects of this scenario is still a challenge. IMPACT: What problem did the study address? This study investigates changes in the mental health status of nursing professionals working at different care levels, taking the prevalence of screening for depression as a proxy, during a period of a year during the COVID-19 pandemic. What were the main findings? Between both data collection moments, 2020 e 2021, there was a significant percentage of professionals with persistent depression, in addition to a significant proportion of incident cases that slightly exceeded the number of remissions and the factors associated with the worst prognoses were sociodemographic aspects such as gender and emotional stressors like illness of family members or close friends due to COVID-19, in addition to those related to the organisation and support provided by the services, such as workload and feeling of overload. Where and on whom will the research have an impact? This study will impact the nursing professionals and in role of the health services in order to establishing actions that contribute to minimising the deleterious effects of the pandemic on the mental health of their Nursing teams. REPORTING METHOD: The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines were adopted in this study. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution.

Prevalence and factors associated with suicidal ideation among family caregivers of people with mental disorders.

AIMS AND OBJECTIVES: This study aimed to analyse the prevalence and factors associated with suicidal ideation among family caregivers of people with mental disorders. BACKGROUND: Studies conducted with family caregivers of people with dementia and cancer point out a high prevalence of suicidal ideation among these subjects; however, this aspect has not yet been investigated among family caregivers of people with mental disorders. DESIGN: This is a cross-sectional study, conducted with 537 family caregivers of patients from 16 Psychosocial Care Centers (CAPS) of the 21st Health Region of the state of Rio Grande do Sul, Brazil. METHODS: Question 17 of the Self-Reporting Questionnaire (SRQ-20) was used for suicidal ideation screening. The prevalence of suicidal ideation was calculated according to sociodemographic and care variables, with confidence interval estimate (95% CI). Crude and adjusted odds ratios were calculated by logistic regression. The Guidelines to Reporting of Observational Studies in Epidemiology (STROBE Statement) was adhered in this study (See File S1). RESULTS: The prevalence of suicidal ideation found in this study for the 30 days preceding the interview was 12.5% (95% CI: 10-15). The factors associated with the outcome were lower age, lower schooling, feeling of burden, self-report of stress problem and dissatisfaction with family relationships. CONCLUSION: The prevalence of suicidal ideation among the studied family caregivers was high and strongly associated with issues regarding care, showing the need for interventions that provide support. RELEVANCE FOR CLINICAL PRACTICE: Nurses are a large part of the workforce of the community mental health services. The careful characterisation of the subjects who show suicidal ideation, as performed in this study, may reveal specificities capable of refining the diagnostic potential for establishment of action plans in a timely manner, avoiding possible attempts or even the consummation of suicide.

Being autonomous: what do mental health services indicate? / Ser autônomo: o que os serviços de saúde mental indicam?

OBJECTIVE: To build qualitative outcome indicators in psychosocial care regarding autonomy from the perspective of users and their families. METHODOLOGY: This is an evaluative case study based on the dialectical hermeneutics theoretical framework, conducted at a mental health community service, in the state of Rio Grande do Sul, Brazil. The first stage of data collection occurred between February and July 2014, and consisted of constructing indicators based on qualitative data analysis of the two evaluative studies conducted at this same service. The second stage, between August and September 2014, consisted of validating the indicators constructed through the focus groups with nine users and nine family members. RESULTS: The users and relatives stated three qualitative indicators related to their autonomy resulting from their insertion in the service. The indicators were better self-management of income, improved everyday activities, and greater bargaining power. CONCLUSION: The methodology proved appropriate to create qualitative indicators, from the perspective of the participants, and revealed that the service helps users achieve autonomy.

Mental health care network: the views of coordinators of the Family Health Strategy (FHS). / Rede de cuidado em saúde mental: visão dos coordenadores da estratégia saúde da família.

OBJECTIVE: This study aimed to analyze the opinions of the coordinators of the Family Health Strategy (FHS) on the mental health care network in the city of Pelotas/RS. METHOD: Descriptive and exploratory study with a qualitative approach, carried out with six FHS coordinators, in 2012. Semi-structured interview was used in data collection, and the results were evaluated using the thematic analysis. RESULTS: The network designed by the coordinators consists of few formal services and is focused on the Psychosocial Care Centers (CAPS). The informal network has a greater number of care units. Exchange of information related to joint responsibilities in the care is scarce, with lack of dialogue. CONCLUSION: The coordinators have scarce knowledge on the formal care network and on care focused on the ESF and CAPS. They also recognize the importance public policies that value and expand the informal care spaces in the territory.

Interfaces between services and actions of the psychosocial care network for children and adolescents. / Interfaces entre serviços e ações da rede de atenção psicossocial às crianças e adolescentes.

OBJECTIVE: To ascertain the actions and partnerships that make up the psychosocial care network for children and adolescents assisted at the CAPSi. METHOD: Qualitative research conducted with twenty-six workers of the intersectoral network of São Lourenço do Sul/RS, Brazil through semi-structured interviews, from May to June in 2014. The data were analysed using the operative proposal of Minayo. RESULTS: Data analysis led to the identification of three categories: Cross-section arrangements: connections for the realisation of care; Joint strategies in everyday life; and The territory as an extension of care. CONCLUSION: Mental care actions coordinated with the healthcare services and other sectors of the intersectoral network increase the possibility of meeting the needs of children and adolescents.

[The meanings constructed in the attention to a crisis in the territory: the psychosocial care center as a protagonist]. / Os sentidos construidos na atenção à crise no território: o centro de atenção psicossocial como protagonista.

The attention to a crisis is a strategic point in the process of paradigm changes proposed by the Brazilian psychiatric reform, requiring changes in alternative services and in the professionals that must use new technologies of care. This study aimed to identify the actions of attention to a crisis in the territory and the meanings as they evolved, beginning from the discursive practices of the professionals. It was a qualitative study that used the theoretical perspective of social constructionism. From the database of the research, Evaluation of the Psychosocial Care Centers in Southern Brazil (CAPSUL), 27 interviews were analyzed from the professionals of Psychosocial Care Center for Alegrete, along with field diaries with 390 hours of observation. Results showed patient engagement/welcoming and accountability for care. We concluded that freedom, reciprocity, contractuality and responsibility for care were the new meanings needed for the alternative care services to overcome the asylum and sense of exclusion and dangerousness.

[The structure and flow of the health care network as an instrument of change in psychosocial assistance services]. / Estrutura e fluxo da rede de saúde como possibilidade de mudança nos serviços de atenção psicossocial.

Changes in mental health care demand changes in the structure and function of health care networks. The aim of the present study was to understand how workers assess the structure of their network and how they use it as a tool for psychosocial rehabilitation. The present qualitative study is part of a larger research project, Rehabilitating networks - assessing experiences of innovation in network development for psychosocial care . Interviews were conducted with six workers at the Therapeutic Home Service (THS) of Alegrete, and four field observation notebooks were analyzed. The results revealed the transversal nature of the investigated network, the relationships between its various components, the strategies used to make non-institutionalized care effective, the responsibilities of the network users, and the relationships between the residents and the workers in the service and at home. In conclusion, the Alegrete network facilitates exchanges between the participants, which indicates that future work should focus on the subjects of reflection and transformation.

Advanced Practice Nursing: "Training" Pillar in Supporting the Proposal in Brazil.

OBJECTIVES: to present the pillars that support what has been called Advanced Practice Nursing and discuss the necessary training for its implementation. METHODS: elements contained in assessment documents for graduate programs proposals, reports of presentations by international professors in countries and selected scientific publications were gathered to compose the argument. RESULTS: practice/competency (adds broad and in-depth knowledge about health processes and scientific evidence, clinical reasoning and clinical skills for therapeutic indications); 3) professional regulation (corresponding legislation and monitoring); and 4) funding (broad training and professional practice policy). FINAL CONSIDERATIONS: the agenda for implementing Advanced Practice Nursing in Brazil involves joining efforts to identify stakeholders for a work to legitimize their importance in the country's health and education overview.

Minor psychiatric disorders among university students during the COVID-19 pandemic.

OBJECTIVE: To identify the prevalence and factors associated with the manifestation of Minor Psychiatric Disorders (MPD) among university students in southern Brazil during the COVID-19 pandemic. METHOD: Cross-sectional study, conducted in August and September 2020, with 464 university students. The Self-Reporting Questionnaire (SRQ-20) was used with a cut-off point ≥ 7, and associated factors were identified through crude and adjusted analyses using logistic regression. RESULTS: The prevalence of MPD was 76.5%. Factors positively associated with the outcome were female gender, job loss during the pandemic, use of psychoactive substances, and difficulties in following online classes. Being in social distancing for seven months or more was negatively associated with the outcome. CONCLUSION: High prevalence of MPD among the studied sample, as well as a relationship between this outcome and the consequences of the COVID-19 pandemic.

[Profile of family caregivers of users of psychosocial care centers of southern Brazil]. / Perfil dos familiares cuidadores de usuários de centros de atenção psicossocial do sul do Brasil.

This study aimed to describe the profile of the families of users of psychosocial care centers (CAPS) in southern Brazil. This is a quantitative, cross-sectional study, with a descriptive approach. It is connected to the research "Evaluation of CAPS in southern Brazil (CAPSUL)". Data collection was conducted from May to June, 2006. 936 families of CAPS users answered a structured questionnaire. A database in the computer program Epi-info 6.04 was built, and statistical analysis was performed through Software Stata 7. It was evident that family caregivers are predominantly women averaging 49.2 years of age, with low education, married without a paid job and taking care by themselves of the family member with mental disorders. These results underscore the need for health services to develop actions in order to include these families in the focus of care of the multiprofessional patient care team.

The (mis)government in the COVID-19 pandemic and the psychosocial implications: discipline, subjection, and subjectivity.

OBJECTIVE: to analyze the psychosocial implications arising from the COVID-19 pandemic, reported in online service, from the perspective of Michel Foucault's concepts of biopower, biopolitics and governmentality. METHOD: qualitative documental research, with analysis of medical records of users assisted in a therapeutic listening chat, between April and October 2020. RESULTS: the data were organized into two themes: Governmentality in the COVID-19 pandemic and the production of psychosocial implications of anxiety and fear and Discipline and subjection in the COVID-19 pandemic: subjectivities marked by sadness and anguish. The first demonstrates that the "art of governing" in Brazil produced instabilities and uncertainties that influenced the production of fear of contamination/death/and non-access to treatment and anxiety. In the second theme, we can see how disciplinary control and biopolitical regulation are combined. In Brazil, an extremely unequal country, subjectivity and subjectivities marked by anguish, feelings of discouragement and sadness have been produced. CONCLUSION: the exclusionary processes were deepened in the pandemic, with the exercise of a biopolitics that makes life precarious and produces psychological distress.

Prevalence and factors associated with poor sleep quality among nursing professionals during the COVID-19 pandemic.

OBJECTIVE: to identify the prevalence and factors associated with poor sleep quality among nursing professionals during the COVID-19 pandemic. METHOD: a cross-sectional study, conducted in June and July 2020, with 890 nursing professionals. To screen the outcome, question 3 of the Self-Reporting Questionnaire was used, assessing poor sleep quality 30 days preceding the application of the questionnaire. Associations between variables of interest were tested using Poisson regression models. RESULTS: the prevalence of poor sleep quality was 68%. Associated factors were moderate or heavy workload, poor assessment of working conditions, suspected infection with COVID-19, more than two thirds of the workload for pandemic and the use of psychotropic drugs. CONCLUSION: the study pointed out a high prevalence of poor sleep quality among nursing workers with an important relationship with working conditions.

Intention to leave Nursing during the COVID-19 pandemic. / Intenção em deixar a Enfermagem durante a pandemia de COVID-19.

OBJECTIVE: to investigate the percentage of professionals with an intention to leave Nursing during the COVID-10 pandemic, as well as the factors associated with this outcome. METHOD: a cross-sectional study conducted by applying questionnaires to 890 Nursing professionals from the municipality of Pelotas (RS). The outcome was identified by means of self-reports obtained from the question itself. Relative Risks, as well as their Confidence Intervals (95%), were calculated for the independent variables by means of unadjusted and adjusted Poisson regression. RESULTS: the percentage of professionals who stated their intention to leave Nursing was 24.6% (n=219). There was a positive association between the outcome and higher schooling levels, negative evaluation of institutional support, moderate or intense overload, and skin lesions. A negative association was also observed between the outcome and individuals aged 51 years old or more. CONCLUSION: except for skin lesions, aspects such as lack of support and overload, although they may have been intensified during the pandemic, do not represent a new fact in the health services. In this sense, the associations found in the study reflect the need for cross-sectional actions to promote retention of professionals.

[Qualitative evaluation of the work process in a psychosocial care center in Brazil]. / Avaliação qualitativa do processo de trabalho em um centro de atenção psicossocial no Brasil.

OBJECTIVE: This study's objective was to evaluate the work process in a psychosocial treatment center. We endeavored to identify areas of difficulty, gaps, deficiencies, potentialities, and experiences shared by the people involved in the service's day-to-day routine (users, family members, and health staff). METHODS: Qualitative evaluation study that used fourth-generation evaluation as the theoretical-methodological framework. RESULTS: We observed some basic characteristics that reveal the organization of the mental health work process from the perspective of the interest groups studied. The use of inclusive care technologies stands out, along with interdisciplinary team-based care management mechanisms centered on the user. CONCLUSIONS: The results contribute to a rereading of the consolidation of psychiatric reform in the brazilian context, raising questions about practice, knowledge, objectives, philosophies, and the goal of health work.

[Work as a source of pleasure: evaluating a Psychosocial Care Center team]. / O trabalho como fonte de prazer: avaliação da equipe de um Centro de Atenção Psicossocial.

The objective of this study was to evaluate the pleasure at work felt by the members of a Psychosocial Care Center team. This qualitative case study used Forth Generation Evaluation. This study was performed in Foz do Iguaçu, Parana, Brazil, in November and December 2006. Participants were 10 tem members. Data collection was performed through observation and individual interviews. The analysis was initiated at the same time as the data collection, and the final analysis was performed as per the following steps: data ordering, classification and final analysis. The following analysis themes were developed: work characteristics at the psychological care center, suffering and coping with suffering at work. During the evaluation, the participants showed pleasure and fulfillment with their work by expressing pride, fulfillment and appreciation of what they deliver. Pleasure occurs during the development of psychosocial care, because they always have the freedom to rearrange their manner of working, making possible to develop activities and attitudes capable of giving them pleasure.

[The supply and use of psychotropic drugs in Psychosocial Care Centers in Southern Brazil]. / Descrição de oferta e consumo dos psicofármacos em Centros de Atenção Psicossocial na Região Sul brasileira.

The description of the supply and use of psychotropic drugs at the Centers for Psychosocial Care (CAPS) is relevant for the effectiveness of assistance from mental health services. The objective was to describe the use and supply of these drugs in CAPS types I and II, in Southern Brazil. This is a cross-sectional study, in which surveys were conducted, in May and June 2006, on the structural aspects of the referred service using charts of 1162 users, and self-applied questionnaires answered by 30 engineers working at CAPS where these users were being monitored. Users were identified as mostly female, adult, middle-aged, low economic status, mainly with a diagnosis of major depression and using antidepressants. It was also found that there might be a lack of distribution and supply of psychotropic drugs in the public health system (SUS) network, which affects the drug therapy of this specialized mental health service, given the socioeconomic conditions of the users.

[Evaluation of users' satisfaction regarding mental health care in the Family Health Strategy]. / Avaliação da satisfação dos usuários com o cuidado da saúde mental na Estratégia Saúde da Família.

The objective of this study is to evaluate the satisfaction of patients with mental suffering regarding the comprehensiveness of the treatment they received from the Family Health Strategy. This case study was developed based on an evaluation study with a qualitative approach at a family health care unit in Chapecó, Santa Catarina. Subjects were 13 users with some kind of mental disorder. The following seven domains were used to evaluate satisfaction: autonomy, confidentiality, communication, respectful treatment, immediate treatment, basic facility conditions, and accessibility to social support networks. It was found that users perceived the strengths and weaknesses of service organization and of the care that was provided: the attachment, the relationship between the team and the community, care with the family, home visits, and the health professionals comprehensive view in the physical exam were reported to be reasons for the users' satisfaction.

[Communicative Action: an overview of the management processes of a Psychosocial Care Network]. / Ação Comunicativa: um olhar sobre processos de gestão de uma Rede de Atenção Psicossocial.

This paper is a qualitative evaluation of the main results of an evaluation study on management processes of a Psychosocial Care Network, in the light of the Theory of Communicative Action. The data collection included 19 individual semi-structured interviews with participants of the Management Collegiate and 20 hours of participant observation in eight meetings of this collegiate, from May to September 2015, with analysis using a hermeneutic-dialectic approach. The results showed a complex network of psychosocial care with management processes related to instrumental and communicative actions. Instrumental action was demonstrated in discussions about the rigid use of workflows, rules and protocols; prescriptive actions without collective negotiation and without user inclusion; and medicalization based on technical criteria alone. The communicative action was to be seen in actions of agreement on workflows, discussions and case referrals; intersectoral agreements with the judiciary; and deliberations of the Management Collegiate on cases, which are not solved only with a technical approach. The conclusion drawn is that the management processes of a Psychosocial Care Network are guided by communicative action, but also require overcoming an action defined by instrumental actions alone.

Trata-se de uma avaliação qualitativa, com os principais resultados de um estudo de avaliação sobre processos de gestão de uma Rede de Atenção Psicossocial à luz da Teoria da Ação Comunicativa. A coleta de dados incluiu 19 entrevistas individuais semiestruturadas com participantes do Colegiado Gestor e 20 horas de observação participante em oito reuniões deste colegiado, de maio a setembro de 2015, com análise de abordagem hermenêutica-dialética. Os resultados apontaram uma complexa rede de atenção psicossocial com processos de gestão relacionados com o agir instrumental e com o agir comunicativo. O agir instrumental foi demonstrado em discussões sobre a utilização rígida de fluxos, normas e protocolos; ações prescritivas sem negociação coletiva e sem inclusão do usuário; e medicalização baseada apenas em critérios técnicos. O agir comunicativo evidenciou-se em ações de pactuação de fluxos, discussões e encaminhamento de casos; pactuações intersetoriais com o judiciário; e deliberações do Colegiado Gestor sobre casos, que não se resolvem apenas com o tecnicismo. Conclui-se que processos de gestão de uma Rede de Atenção Psicossocial são orientados por um agir comunicativo, mas ainda requerem a superação de um agir capturado somente por ações instrumentais.

[Use of psychotropic drugs and its association with overburden on family caregivers of psychosocial care center users]. / Uso de psicotrópicos e sua associação com sobrecarga em familiares cuidadores de usuários de centros de atenção psicossocial.

The scope of this study was to investigate the prevalence of psychotropic drug use and its association with the overburden felt by family caregivers of Psychosocial Care Center users. This is a cross-sectional study performed with 537 family caregivers in the 21st Health Region of the State of Rio Grande do Sul. The prevalence of psychotropic drug use was calculated with a 95% confidence interval (95%CI) and the heterogeneity tests were performed between the strata of each independent variable. The association between psychotropic drug use and overburden was tested using Poisson regression with the calculation of the adjusted prevalence ratios. The prevalence of psychotropic drug use was 30%, with higher consumption among women (40%), individuals aged 41 -50 years (42.06%), with 5 to 8 years of schooling (37.57%), with income between 0.5 and 1 minimum wage per capita (34.43%), individuals who did not share caregiving duties (35.53%) and those who cared for patients with a major degree of independence (36.67%). The overburden felt was in direct relationship with the outcome, namely the higher the level of overburden the greater the prevalence of psychotropic drug use, reaching 60.1% at the highest level and remaining strongly associated with the outcome even in the adjusted analysis.

O objetivo deste estudo foi investigar a prevalência de uso de psicotrópicos e sua associação com o sentimento de sobrecarga entre familiares cuidadores de usuários de Centros de Atenção Psicossocial. Trata-se de um estudo transversal, conduzido com 537 familiares da 21ª Região de Saúde do Estado do Rio Grande do Sul. A prevalência de uso de psicotrópicos foi calculada com estimativa do intervalo de confiança (IC95%) e foram conduzidos testes de heterogeneidade entre os estratos de cada variável independente. Associação entre o desfecho e o sentimento de sobrecarga foi testada por meio de regressão de Poisson com o cálculo das razões de prevalência ajustadas. A prevalência do uso de psicotrópicos foi de 30%, havendo maior consumo entre mulheres (40%), indivíduos entre 41 e 50 anos (42,06%), com escolaridade entre 5 a 8 anos de estudo (37,57%), renda entre 0,5 a 1 salário mínimo per capita (34,43%), indivíduos que não compartilhava as ações do cuidado (35,53%) e indivíduos que assistiam pacientes com maior grau de independência (36,67%). Sentimento de sobrecarga apresentou relação dose resposta com o desfecho no sentido de que quanto maior o grau de sobrecarga, maior a prevalência do uso de psicotrópicos, chegando a 60,1% no estrato mais elevado e permanecendo fortemente associada ao desfecho mesmo na análise ajustada.

Prevalence of psychotropic drug use and conformity of therapeutic dose among mental health users.

OBJECTIVES: to identify the prevalence of psychotropic drug use according to their Anatomical Therapeutic Chemical classification among Psychosocial Care Center users and assess their prescription compliance based on the recommended therapeutic dose. METHODS: this is an analytical study, based on documents, from the study of 389 records between September 2017 and May 2018. Associations between the presence of underdose or overdose and participants' characteristics were assessed using the chi-square test, adopting a significant value of p <0.05. RESULTS: the most used drugs were antipsychotics (74.7%), 16.0% of users with at least one medication with a dose below the therapeutic level and another 3.6% above the recommended therapeutic dose. CONCLUSIONS: greater nonconformities in the prescribed dose were related to antihistamines, antipsychotics and antidepressants, with underdosage associated with females and overdose with the report of hearing voices.