Childhood poverty and mental health disorders in early adulthood: evidence from a Brazilian cohort study.

BACKGROUND: We examined the association between childhood poverty and mental health disorders (MHD) in childhood and early adulthood. We also investigated whether the association between poverty in childhood and MHD is mediated by exposure to stressful life events (SLE). METHODS: We used data from a prospective community cohort of young people assessed at baseline (M = 9.7 years, SD = 1.9), first (M = 13.5 years, SD = 1.9), and second (M = 18.2 years, SD = 2.0) follow-ups (N = 1,590) in Brazil. Poverty was assessed using a standardized classification. Exposure to 20 different SLE was measured using the Life History instrument. Psychiatric diagnoses were evaluated using the Development and Well-Being Assessment. Latent growth models investigated the association between poverty at baseline and the growth of any MHD, externalizing, and internalizing disorders. Mediation models evaluated whether the association between childhood poverty and MHD in early adulthood was mediated by exposure to SLE. RESULTS: Poverty affected 11.4% of the sample at baseline and was associated with an increased propensity for presenting externalizing disorders in adolescence or early adulthood (standardized estimate = 0.27, p = 0.016). This association was not significant for any disorder or internalizing disorders. Childhood poverty increased the likelihood of externalizing disorders in early adulthood through higher exposure to SLE (OR = 1.07, 95 CI% 1.01-1.14). Results were only replicated among females in stratified analyses. CONCLUSIONS: Childhood poverty had detrimental consequences on externalizing MHD in adolescence, especially among females. Poverty and SLE are preventable risk factors that need to be tackled to reduce the burden of externalizing disorders in young people.

Childhood individual and family modifiable risk factors for criminal conviction: a 7-year cohort study from Brazil.

Crime is a major public problem in low- and middle-income countries (LMICs) and its preventive measures could have great social impact. The extent to which multiple modifiable risk factors among children and families influence juvenile criminal conviction in an LMIC remains unexplored; however, it is necessary to identify prevention targets. This study examined the association between 22 modifiable individual and family exposures assessed in childhood (5-14 years, n = 2511) and criminal conviction at a 7-year follow-up (13-21 years, n = 1905, 76% retention rate) in a cohort of young people in Brazil. Population attributable risk fraction (PARF) was computed for significant risk factors. Criminal convictions were reported for 81 (4.3%) youths. Although most children living in poverty did not present criminal conviction (89%), poverty at baseline was the only modifiable risk factor significantly associated with crime (OR 4.14, 99.8% CI 1.38-12.46) with a PARF of 22.5% (95% CI 5.9-36.1%). It suggests that preventing children's exposure to poverty would reduce nearly a quarter of subsequent criminal convictions. These findings highlight the importance of poverty in criminal conviction, as it includes several deprivations and suggest that poverty eradication interventions during childhood may be crucial for reducing crime among Brazilian youth.

Adaptação transcultural de uma escala de satisfação dos moradores com os serviços das residências terapêuticas / Transcultural adaptation of a satisfaction scale for the residents of therapeutic residences / Adaptación transcultural de una escala de satisfacción de residentes en cuanto a los servicios de residencias terapéuticas

A satisfação dos usuários constitui um dos critérios da qualidade dos serviços de saúde mental. Entretanto, há uma carência de estudos avaliando a satisfação dos moradores de residências terapêuticas (RTs) e ausência de instrumento de medida específico para este fim, no Brasil. Neste estudo, foi feita a adaptação transcultural do Questionnaire sur la Satisfaction de la Clientèle en Résidence D'Accueil (QSHS-21), para avaliar a satisfação dos moradores das RTs. O procedimento incluiu: tradução da escala original, retradução, revisão por Comitê de Especialistas e Estudo Piloto com 30 moradores de RTs do município de Barbacena/MG. Os resultados incluíram correções a partir das traduções e retraduções e adaptação da escala pelo Comitê de Especialistas, assim como modificações na redação de algumas questões, no Estudo Piloto. A versão final possui equivalência semântica e conceitual com a escala original e está adaptada ao contexto brasileiro, sendo de fácil compreensão para a população-alvo.

Users' satisfaction is a measure of mental health services quality. However, few studies evaluated residents' satisfaction regarding the Therapeutic Residences (TR) and there is no specific instrument in brazilian context for this evaluation. In this study, we made the transcultural adaptation of the Questionnaire sur la Satisfaction de la Clientèle en Résidence D'Accueil (QSHS-21), to evaluate the residents' satisfaction in the TR. The procedure included: translation of the original scale, re-translation, analyses by an Expert Commitee and a Pilot Study with 30 TR residents in the city of Barbacena-MG. Results showed corrections of the translations and retranslations and adaptation of the scale by the Expert Commitee and modifications in the questions wording during the Pilot Study. The final version of the scale has semantic and conceptual equivalence with the original scale, is adapted to the brazilian context and is easy to understand by the target population.

La satisfacción de los usuarios es un criterio de calidad de los servicios de salud mental. Sin embargo, faltan estudios que evalúen la satisfacción de los residentes de residencias terapéuticas (RTs) y en Brasil hay ausencia de un instrumento de medición específico para este fin. Este estudio adaptó el Questionnaire sur la Satisfaction de la Clientèle en Résidence D'Accueil (QSHS-21), para evaluar la satisfacción de los residentes de las RTs. El procedimiento incluyó: traducción de la escala original, retraducción, revisión por el Comité de Especialistas y Estudio Piloto con 30 residentes en Barbacena-MG. Los resultados mostraron correcciones de traducciones y retraducciones, y adaptación de la escala por parte del Comité de Especialistas, y cambios en la redacción de las preguntas, en el Estudio Piloto. La versión final tiene equivalencia semántica y conceptual con la escala original y está adaptada al contexto brasileño, siendo de fácil comprensión para el público de RTs.

Evaluation of Ongoing Participation of People with Schizophrenia in a Mutual Support Group as a Complementary Intervention to Outpatient Psychiatric Treatment.

This study aims to evaluate a group of people with schizophrenia undergoing outpatient treatment and who participate in a mutual support intervention, compared to another group of people with the same diagnosis, but attending only the usual outpatient treatment. This is a prospective study, with two measurements between six months. The mutual support group was initially composed of 16 people and the treatment as usual group was composed of 15 people. Clinical (medication adherence and functioning) and Recovery (hope, well-being, recovery and internalized stigma) outcomes were assessed. Nonparametric tests were used to verify differences in measurements between groups and between two moments. A higher level of internalized stigma and a decrease in the adherence to drug treatment in the treatment as usual group were verified. When comparing the pre-post difference between groups, there was a greater increase in adherence to drug treatment in the mutual support group. Our data point to more favorable results in the mutual support group, showing that ongoing participation in these groups is an important tool for the recovery process and for the treatment itself.

Need for information in a representative sample of outpatients with schizophrenia disorders.

BACKGROUND: Providing adequate information and involving patients in treatment have become an essential component of mental health care. Despite this, research regarding the extent to which this need has been met in clinical services is still scarce. AIMS: To investigate the need for information about psychiatric condition and treatment among outpatients with schizophrenia disorders and how this need is associated with service use, adjusting for sociodemographic and clinical characteristics. METHODS: Need for information about condition and treatment, using the corresponding domain in the Camberwell Assessment of Need (CAN), in a representative sample of 401 schizophrenia outpatients in Santos, Brazil was assessed. Hierarchical logistic regression was used to investigate the association of information as a reported need and as an unmet need with service use variables, adjusting for sociodemographic and clinical characteristics. RESULTS: Need for information was reported by 214 (53.4%) patients, being met in 101 (25.2%) and unmet in 113 (28.2%). Hierarchical regression indicated a significant association of a reported need with higher age of onset, family monitoring medication use last year and lower education level, which was only associated with an unmet need. CONCLUSION: Information was a commonly reported need and which was often unmet, showing no significant association with service use. Greater attention should be given by mental health services to information provision.

Income inequality and mental illness-related morbidity and resilience: a systematic review and meta-analysis.

BACKGROUND: Studies of the association between income inequality and mental health have shown mixed results, probably due to methodological heterogeneity. By dealing with such heterogeneity through a systematic review and meta-analysis, we examine the association between income inequality, mental health problems, use of mental health services, and resilience (defined as the ability to cope with adversity). METHODS: We searched the Global Health, PsychARTICLES, PsycINFO, Social Policy and Practice, Embase and MEDLINE databases up to July 6, 2016, for quantitative studies of the association of income inequality with prevalence or incidence of mental disorders or mental health problems, use of mental health services, and resilience. Eligible studies used standardised instruments at the individual level, and income inequality at the aggregated, contextual, and ecological level. We extracted study characteristics, sampling, exposure, outcomes, statistical modelling, and parameters from articles. Because several studies did not provide enough statistical information to be included in a meta-analysis, we did a narrative synthesis to summarise results with studies categorised as showing either a positive association, mixed results, or no association. The primary outcome in the random-effects meta-analysis was mental health-related morbidity, defined as the prevalence or incidence of any mental health problem. This study is registered with PROSPERO, number CRD42016036377. FINDINGS: Our search identified 15 615 non-duplicate references, of which 113 were deemed potentially relevant and were assessed for eligibility, leading to the inclusion of 27 studies in the qualitative synthesis. Nine articles found a positive association between income inequality and the prevalence or incidence of mental health problems; ten articles found mixed results, with positive association in some subgroups and non-significant or negative association in other subgroups; and eight articles found no association between income inequality and mental health problems. Of the nine articles included in our meta-analysis, one reported a positive association between income inequality and mental health problems, six reported mixed results, and two reported no association. Pooled Cohen's d effect sizes for the association between income inequality and any mental disorder or mental health problems were 0·06 (95% CI 0·01-0·11) for any mental disorder, and 0·12 (0·05-0·20) for depressive disorders. Our meta-regression analysis showed that none of the factors considered (sample size, contextual level at which income inequality was assessed, quality assessment, type of instruments, and individual income as control variable) explained heterogeneity between studies (I2 89·3%; p<0·0001). Only one study investigated the association between income inequality and resilience; it found greater income inequality was associated with higher prevalence of depression only among individuals with low income. The only study of the role of income inequality as a determinant of the use of mental health services reported no association. INTERPRETATION: Income inequality negatively affects mental health but the effect sizes are small and there is marked heterogeneity among studies. If this association is causal and growing income inequality does lead to an increase in the prevalence of mental health problems, then its reduction could result in a significant improvement in population wellbeing. FUNDING: None.

Increasing Awareness and Acceptance Through Mindfulness and Somatic Education Movements.

Context • The main feature of mindfulness-based interventions (MBI) is the encouragement of present moment awareness and of self-regulation, which are associated with health benefits. Meditating with the body in movement has been referred to as one of the most accessible ways of reaching such awareness. An MBI program, Mindfulness and Movements of Integration (MMI), has the same structure as mindfulness-based stress reduction (MBSR) but puts more emphasis on the body and uses somatic education (SE) movements instead of yoga postures. Objectives • The study aimed to explore and describe the implementation of an MMI group and evaluate the effects on the main skills of mindfulness (ie, present moment awareness and acceptance). Design • The study used a pretest-posttest design. Setting • The study took place at the clinic of the Department of Psychiatry at the Federal University of São Paulo in São Paulo, Brazil. Participants • Participants were individuals 18 y old or older living in the city of São Paulo, Brazil. Intervention • The intervention was structured to have 8 weekly sessions of 2.5 h each and a 1-d retreat. Participants were taught the formal meditation practices derived of MBSR: (1) the body scan and (2) awareness of different focuses-breathing, body sensations, sounds, thoughts, feelings, and open awareness. From the third session until the end of the study, 4 SE series of movements were added. Outcome Measures • The Brazilian adapted and validated versions of both the Mindful Attention Awareness Scale (MAAS) and the Philadelphia Mindfulness Scale (PHLMS) were used to assess present moment awareness, and acceptance was assessed using only the latter scale. Results • Significant improvements were observed in the mean score on the MAAS for present moment awareness (Cohen's d = 1.58). The PHLMS mean scores also showed significant improvements related to the Awareness (Cohen's d = 0.85) and Acceptance (Cohen's d = 0.63) subscales. However, the correlation between the changes in scores in those subscales was not significant (r = .29; P = .29). Conclusions • The results point to the MMI program as a potentially acceptable and useful MBI by increasing awareness and acceptance through mindfulness and SE movements.

Subjective distress in a representative sample of outpatients with psychotic disorders.

BACKGROUND: The affective burden of psychotic disorder has been increasingly recognised. However, subjective reports of distress and its covariates, especially those related to service use, remain under-investigated in patients with psychosis. METHODS: This study investigated subjective distress and its covariates in a representative sample of 401 outpatients with a confirmed diagnosis of psychotic disorders in Brazil. Distress was assessed using the corresponding domain of a standardised measure of need - the Camberwell Assessment of Need. RESULTS: Distress was reported as a need by 165 (41%) patients, being met in 78 (20%) and unmet in 87 (22%). Hierarchical logistic regression showed that the presence of distress as a need was predicted by attendance at psychotherapy (OR=3.49, CI=1.62-7.53), presence of suicidal ideation (OR=2.89, CI=1.75-4.79), non-attendance at psychosocial rehabilitation (OR=2.84, CI=1.31-6.19), and higher psychopathology (OR=1.09, CI=1.06-1.12). An unmet need was predicted by family not accompanying patients to treatment (OR=2.60, CI=1.05-6.44) and higher psychopathology (OR=1.05, CI=1.02-1.09). LIMITATION: The use of a cross-sectional design and a single questionnaire domain to evaluate distress are the main limitations. CONCLUSIONS: Subjective distress is a common unmet need in psychosis, and can be treated. The main clinical implication is that subjective distress in psychosis may be impacted on by family engagement and psychosocial interventions.

The relationship between symptomatic changes and perceived improvement among patients treated in Brazilian community mental health services.

Perceived improvement has been proposed as an important patient-reported outcome measure in mental health services evaluation. One advantage of this measure is that it can indicate whether other outcome measures, as pre-post differences in symptoms, correspond to a noticeable impact in patients' lives, as assessed by themselves. This study investigated the association between observer and self-reported symptomatic changes and perceived improvement by patients treated in two Brazilian outpatient mental health services. Significant and positive correlations were found between perceived improvement scores and both pre-post differences, obtained in observer-reported and patient-reported symptom scores. Nevertheless, scores of perceived improvement showed to be more correlated to patient-reported than to the observer-rated symptomatic change score. In addition, a greater correlation was found between perceived improvement scores and post-treatment symptom scores, compared to pre-treatment. These results suggest that an improvement in symptom severity, measured by pre-post differences scores, corresponds to the patient perception that he is actually better than before. However, the correlations found were moderate, suggesting that other factors may also be related to perceived improvement and must be investigated in further studies.

Percepção dos pacientes sobre o tratamento em serviços de saúde mental: validação da Escala de Mudança Percebida / Patient's perception on the treatment in mental Health services: validating the Perception of Change Scale - patient version

Na avaliação de serviços de saúde mental, tem-se destacado as escalas de medida que avaliam os resultados do tratamento relatados pelos próprios pacientes. O objetivo desta pesquisa foi validar a Escala de Mudança Percebida (EMP) pelos pacientes. Trezentos pacientes psiquiátricos, atendidos em serviços de saúde mental, participaram de entrevistas individuais estruturadas, com a escala. A escala possui 19 itens que avaliam mudanças percebidas, com alternativas de resposta em escala do tipo Likert de 3 pontos. Análise pelo método dos Componentes Principais resultou em estrutura de 3 fatores: a) Ocupação e saúde física; b) Aspectos psicológicos e sono; c) Relacionamentos e estabilidade emocional. A escala apresentou boa consistência interna (Alfa de Cronbach= 0,85), estabilidade temporal teste-reteste (r=0,93; p<0,05) e validade convergente com uma escala que avalia o construto teoricamente relacionado de satisfação com o serviço (r=0,37; p<0,05).(AU)

The evaluation of mental health services has stressed the use of patient-reported outcome scales. Thus, this research aimed at validating the Perception of Change Scale - Patient Version (PCS-P). Three hundred psychiatric patients, attending mental health services, participated in individual structured interviews which use the scale. The scale has 19 items which evaluate perceived changes and response alternatives disposed in a three-point Likert-type scale. Analysis using the Principal Components Method revealed a 3-factor structure: (a) occupation and physical health; (b) psychological aspects and sleeping condition; (c) relationships and emotional stability. The scale had good indices of internal consistency (Cronbach alpha = 0.85), test-retest temporal stability (r = 0.93; p<0.05) and convergent validity with another scale evaluating the related construct of service satisfaction (r = 0.37; p<0.05).(AU)

Percepção dos pacientes sobre o tratamento em serviços de saúde mental: validação da Escala de Mudança Percebida / Patient's perception on the treatment in mental Health services: validating the Perception of Change Scale - patient version

Na avaliação de serviços de saúde mental, tem-se destacado as escalas de medida que avaliam os resultados do tratamento relatados pelos próprios pacientes. O objetivo desta pesquisa foi validar a Escala de Mudança Percebida (EMP) pelos pacientes. Trezentos pacientes psiquiátricos, atendidos em serviços de saúde mental, participaram de entrevistas individuais estruturadas, com a escala. A escala possui 19 itens que avaliam mudanças percebidas, com alternativas de resposta em escala do tipo Likert de 3 pontos. Análise pelo método dos Componentes Principais resultou em estrutura de 3 fatores: a) Ocupação e saúde física; b) Aspectos psicológicos e sono; c) Relacionamentos e estabilidade emocional. A escala apresentou boa consistência interna (Alfa de Cronbach= 0,85), estabilidade temporal teste-reteste (r=0,93; p<0,05) e validade convergente com uma escala que avalia o construto teoricamente relacionado de satisfação com o serviço (r=0,37; p<0,05).

The evaluation of mental health services has stressed the use of patient-reported outcome scales. Thus, this research aimed at validating the Perception of Change Scale - Patient Version (PCS-P). Three hundred psychiatric patients, attending mental health services, participated in individual structured interviews which use the scale. The scale has 19 items which evaluate perceived changes and response alternatives disposed in a three-point Likert-type scale. Analysis using the Principal Components Method revealed a 3-factor structure: (a) occupation and physical health; (b) psychological aspects and sleeping condition; (c) relationships and emotional stability. The scale had good indices of internal consistency (Cronbach alpha = 0.85), test-retest temporal stability (r = 0.93; p<0.05) and convergent validity with another scale evaluating the related construct of service satisfaction (r = 0.37; p<0.05).