Setting priorities for mental health research in Brazil / Agenda de prioridades de pesquisa para saúde mental no Brasil

BACKGROUND: The main aim of this study is to review the agenda for research priorities of mental health in Brazil. METHODOLOGY: The first step was to gather 28 experts (22 researchers, five policy makers, and the coordinator) representing all mental health fields from different geographical areas of the country. Participants were asked to list what they considered to be the most relevant mental health research questions for the country to address in the next 10 years. Seventeen participants answered this question; after redundancies were excluded, a total of 110 responses were collected. As the second step, participants were asked to rank which questions were the 35 most significant. The final step was to score 15 items for each of the 35 selected questions to determine whether it would be a) answerable, b) effective, c) deliverable, d) equitable, and e) effective at reducing the burden of mental health. The ten highest ranked questions were then selected. RESULTS: There were four questions addressing primary care with respect to a) the effectiveness of interventions, b) "matrix support", c) comparisons of different models of stepped care, and d) interventions to enhance identification and treatment of common mental disorders at the Family Health Program. The other questions were related to the evaluation of mental health services for adults and children/adolescents to clarify barriers to treatment in primary care, drug addiction, and severe mental disorders; to investigate the cost-benefit relationship of anti-psychotics; to design interventions to decrease alcohol consumption; and to apply new technologies (telemedicine) for education and supervision of non-specialists. CONCLUSION: This priority-setting research exercise highlighted a need for implementing investments at the primary-care level, particularly in the family health program; the urgent need to evaluate services; and policies to improve equity by increasing accessibility to services and testing interventions to reduce barriers for seeking mental health treatment.

INTRODUÇÃO: O principal objetivo desse estudo foi revisar a agenda de prioridades em pesquisa em saúde mental no Brasil. MÉTODO: Foram selecionados 28 especialistas (22 pesquisadores, cinco legisladores e o coordenador) de diferentes regiões. Responderam ao que consideravam mais relevante em pesquisa para a saúde mental para os próximos 10 anos. Dezessete responderam e configuraram 110 questões, que foram reavaliadas por eles, com atribuição de escore, a partir de 15 itens distribuídos segundo grau de responsividade, eficácia, aplicabilidade, equidade e impacto na redução da carga da doença mental. 35 questões, e dentre elas as 10 mais bem pontuadas, foram destacadas. RESULTADOS: Prevaleceram indicações para estudos de efetividade das intervenções, matriciamento, comparação entre modelos de intervenção e detecção e tratamento de transtornos mais prevalentes na Estratégia da Saúde da Família. Avaliação de serviços quanto às barreiras ao tratamento; custo-efetividade dos antipsicóticos, intervenções contra efeitos do álcool e outras drogas, e aplicação de tecnologias (telemedicina) para educação e supervisão dos generalistas foram outros. CONCLUSÃO: Apontou-se para necessidade de investimentos na saúde mental na atenção primária à saúde; avaliação do sistema de serviços de cuidados de saúde mental, e pesquisas para romper barreiras ao acesso e à equidade no tratamento dos transtornos mentais.

Setting priorities for mental health research in Brazil.

BACKGROUND: The main aim of this study is to review the agenda for research priorities of mental health in Brazil. METHODOLOGY: The first step was to gather 28 experts (22 researchers, five policy makers, and the coordinator) representing all mental health fields from different geographical areas of the country. Participants were asked to list what they considered to be the most relevant mental health research questions for the country to address in the next 10 years. Seventeen participants answered this question; after redundancies were excluded, a total of 110 responses were collected. As the second step, participants were asked to rank which questions were the 35 most significant. The final step was to score 15 items for each of the 35 selected questions to determine whether it would be a) answerable, b) effective, c) deliverable, d) equitable, and e) effective at reducing the burden of mental health. The ten highest ranked questions were then selected. RESULTS: There were four questions addressing primary care with respect to a) the effectiveness of interventions, b) "matrix support", c) comparisons of different models of stepped care, and d) interventions to enhance identification and treatment of common mental disorders at the Family Health Program. The other questions were related to the evaluation of mental health services for adults and children/adolescents to clarify barriers to treatment in primary care, drug addiction, and severe mental disorders; to investigate the cost-benefit relationship of anti-psychotics; to design interventions to decrease alcohol consumption; and to apply new technologies (telemedicine) for education and supervision of non-specialists. CONCLUSION: This priority-setting research exercise highlighted a need for implementing investments at the primary-care level, particularly in the family health program; the urgent need to evaluate services; and policies to improve equity by increasing accessibility to services and testing interventions to reduce barriers for seeking mental health treatment.

Ten-year growth in the scientific production of Brazilian Psychiatry: the impact of the new evaluation policies.

OBJECTIVE: Developed by the Ministry of Education, the Qualis evaluation criteria have strongly impacted the scientific production of Post-Graduation Programs. A new set of more stringent criteria has been proposed for Qualis. Our aim was to evaluate the impact of the new Qualis criteria on the scientific production of Post-Graduation Programs in psychiatry over the last 10 years. METHOD: We extracted data from annual reports published between 1998 and 2008, and compared performance measured in terms of the old Qualis rating criteria and the new set of criteria. RESULTS: There was a 25% increase in the number of Information Science Institute-indexed articles in the second five-year period, which rose from 1,213 to 1,518. While, according to the old Qualis criteria, 84% of the Information Science Institute production would have been classified as highly-rated (IF > 1), only 17% of the papers were classified as highly-rated (A1) according to the new Qualis rating criteria. Most papers (65%) were assigned to intermediate categories (B1 and B2) with an IF < 2.29. DISCUSSION: All psychiatric Post-Graduation Programs have increased their production, but by favoring quality over quantity, the new rules have proved to be more useful for discriminating among the scientific production.

Ten-year growth in the scientific production of Brazilian Psychiatry: the impact of the new evaluation policies / Dez anos de crescimento da produção científica da Psiquiatria brasileira: o impacto das novas políticas de avaliação

OBJECTIVE: Developed by the Ministry of Education, the Qualis evaluation criteria have strongly impacted the scientific production of Post-Graduation Programs. A new set of more stringent criteria has been proposed for Qualis. Our aim was to evaluate the impact of the new Qualis criteria on the scientific production of Post-Graduation Programs in psychiatry over the last 10 years. METHOD:We extracted data from annual reports published between 1998 and 2008, and compared performance measured in terms of the old Qualis rating criteria and the new set of criteria. RESULTS: There was a 25 percent increase in the number of Information Science Institute-indexed articles in the second five-year period, which rose from 1,213 to 1,518. While, according to the old Qualis criteria, 84 percent of the Information Science Institute production would have been classified as highly-rated (IF > 1), only 17 percent of the papers were classified as highly-rated (A1) according to the new Qualis rating criteria. Most papers (65 percent) were assigned to intermediate categories (B1 and B2) with an IF < 2.29. DISCUSSION:All psychiatric Post-Graduation Programs have increased their production, but by favoring quality over quantity, the new rules have proved to be more useful for discriminating among the scientific production.

OBJETIVO: Nosso objetivo foi analisar o impacto dos novos critérios de avaliação de publicações científicas (Qualis) sobre a produção científica de Psiquiatria ao longo dos últimos 10 anos. Os critérios de avaliação do Ministério da Educação têm refletido em forte impacto na produção científica dos Programas de Pós-Graduação. MÉTODO: Extraímos dados dos relatórios anuais publicados entre 1998 e 2008 e comparamos os desempenhos medidos em termos dos antigos critérios de avaliação Qualis e dos novos conjuntos de critérios. RESULTADOS: Houve um aumento de 25 por cento no número de artigos indexados no Information Science Institute no segundo período de cinco anos, que passou de 1.213 para 1.518. Embora, de acordo com os critérios de anteriores do Qualis, 84 por cento da produção Information Science Institute tenha sido classificada como de alta qualificação (IF > 1), apenas 17 por cento dos trabalhos foram classificados como de alta qualificação (A1), de acordo com os novos critérios de avaliação Qualis. A maioria dos trabalhos (65 por cento) foi atribuída a categorias intermediárias (B1 e B2), com IF < 2,29. DISCUSSÃO:Todos os Programas de Pós-Graduação de psiquiatria aumentaram sua produção, porém, favorecendo a qualidade ao invés da quantidade, as novas regras provaram ser de mais utilidade para discriminar a produção científica.

The mental health system in Brazil: Policies and future challenges.

BACKGROUND: The aim of this paper is to assess the mental health system in Brazil in relation to the human resources and the services available to the population. METHODS: The World Health Organization Assessment Instrument for Mental Health Systems (WHO AIMS) was recently applied in Brazil. This paper will analyse data on the following sections of the WHO-AIMS: a) mental health services; and b) human resources. In addition, two more national datasets will be used to complete the information provided by the WHO questionnaire: a) the Executive Bureau of the Department of Health (Datasus); and b) the National Register of Health Institutions (CNS). RESULTS: There are 6003 psychiatrists, 18,763 psychologists, 1985 social workers, 3119 nurses and 3589 occupational therapists working for the Unified Health System (SUS). At primary care level, there are 104,789 doctors, 184, 437 nurses and nurse technicians and 210,887 health agents.The number of psychiatrists is roughly 5 per 100,000 inhabitants in the Southeast region, and the Northeast region has less than 1 psychiatrist per 100,000 inhabitants. The number of psychiatric nurses is insufficient in all geographical areas, and psychologists outnumber other mental health professionals in all regions of the country. The rate of beds in psychiatric hospitals in the country is 27.17 beds per 100,000 inhabitants. The rate of patients in psychiatric hospitals is 119 per 100,000 inhabitants. The average length of stay in mental hospitals is 65.29 days. In June 2006, there were 848 Community Psychosocial Centers (CAPS) registered in Brazil, a ratio of 0.9 CAPS per 200,000 inhabitants, unequally distributed in the different geographical areas: the Northeast and the North regions having lower figures than the South and Southeast regions. CONCLUSION: The country has opted for innovative services and programs, such as the expansion of Psychosocial Community Centers and the Return Home program to deinstitutionalize long-stay patients. However, services are unequally distributed across the regions of the country, and the growth of the elderly population, combined with an existing treatment gap is increasing the burden on mental health care. This gap may get even wider if funding does not increase and mental health services are not expanded in the country. There is not yet a good degree of integration between primary care and the mental health teams working at CAPS level, and it is necessary to train professionals to act as mental health planners and as managers. Research on service organization, policy and mental health systems evaluation are strongly recommended in the country. There are no firm data to show the impact of such policies in terms of community service cost-effectiveness and no tangible indicators to assess the results of these policies.

Em busca da eficiência: visibilidade internacional da produção científica dos programas brasileiros de pós-graduação em saúde infantil e do adolescente entre 1998 e 2003 / Pursuing efficiency: international visibility of the scientific production of Brazilian graduate programs in child and adolescent health from 1998 through 2003

OBJETIVO:Avaliar a tendência do número de publicações oriundos dos programas de pós-graduação brasileiros em saúde da criança e do adolescente e a proporção de citações desses artigos no MEDLINE e no Journal Citation Reports (JCR), utilizando a primeira base de dados como medida de eficiência e a última como indicador de visibilidade. MÉTODOS: Avaliamos 14 programas de pós-graduação quanto ao número de teses, dissertações e artigos citados no MEDLINE e JCR, através de dados secundários das duas últimas avaliações trienais realizadas pela Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), de 1998 até 2000 e de 2001 até 2003. RESULTADOS:O número de artigos publicados aumentou (de 1.520 para 1.917), bem como o número mediano de artigos citados tanto no MEDLINE (de 32,5 para 45) como no JCR (de 24,5 para 27). O número mediano de dissertações aumentou de 19,5 para 26,5; o número mediano de teses cresceu de 12 para 13,5. O número mediano de orientadores diminuiu (de 21,5 para 18,4). CONCLUSÃO: Os programas de pós-graduação em saúde infantil e do adolescente tornaram-se mais eficientes quanto à produção de conhecimento através da publicação de mais artigos com maior visibilidade internacional. Tal tendência foi acompanhada contraditoriamente pela redução no número de orientadores.

OBJECTIVE:To assess the trend in the number of published articles by Brazilian graduate programs in child and adolescent health and the proportion of such publications cited in MEDLINE and Thomson Scientific's Journal Citation Reports (JCR), using the former database as a proxy for efficiency and the latter as an indicator of visibility. METHODS: We assessed the trends of 14 graduate programs concerning the number of theses, dissertations, and articles cited in MEDLINE and JCR, through secondary data from the latest two triennial evaluations carried out by the Brazilian Federal Agency for the Improvement of Higher Education (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, CAPES) between 1998 and 2000 and between 2001 and 2003). RESULTS:The number of published articles increased (1,520 to 1,917), as did the median number of articles cited both in MEDLINE (32.5 to 45) and in JCR (24.5 to 27). The median number of dissertations rose from 19.5 to 26.5; the median number of theses went up from 12 to 13.5. The median number of faculty advisors decreased (21.5 to 18.4). CONCLUSION: Graduate programs in child and adolescent health became more efficient in producing knowledge through the publication of more articles with broader international visibility. Such trend was contradictorily accompanied by a diminishing number of advisors.

Pursuing efficiency: international visibility of the scientific production of Brazilian graduate programs in child and adolescent health from 1998 through 2003.

OBJECTIVE: To assess the trend in the number of published articles by Brazilian graduate programs in child and adolescent health and the proportion of such publications cited in MEDLINE and Thomson Scientific's Journal Citation Reports (JCR), using the former database as a proxy for efficiency and the latter as an indicator of visibility. METHODS: We assessed the trends of 14 graduate programs concerning the number of theses, dissertations, and articles cited in MEDLINE and JCR, through secondary data from the latest two triennial evaluations carried out by the Brazilian Federal Agency for the Improvement of Higher Education (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, CAPES) between 1998 and 2000 and between 2001 and 2003). RESULTS: The number of published articles increased (1,520 to 1,917), as did the median number of articles cited both in MEDLINE (32.5 to 45) and in JCR (24.5 to 27). The median number of dissertations rose from 19.5 to 26.5; the median number of theses went up from 12 to 13.5. The median number of faculty advisors decreased (21.5 to 18.4). CONCLUSION: Graduate programs in child and adolescent health became more efficient in producing knowledge through the publication of more articles with broader international visibility. Such trend was contradictorily accompanied by a diminishing number of advisors.

Leading countries in mental health research in Latin America and the Caribbean.

OBJECTIVE: The prevalence and burden of mental disorders have been growing in Latin-American and the Caribbean countries and research is an important tool for changing this scenario. The objective of this paper is to describe the development of mental health research in Latin American and the Caribbean countries from 1995 to 2005. METHOD: The indicators of productivity were based on the ISI Essential Science Indicators database. We compared the number of papers and citations, as well as the number of citations per paper between 1995 and 2005 for each country ranked in the Essential Science Indicators. RESULT: Eleven Latin-American countries were ranked in the ISI database and six of them demonstrated a higher level of development in mental health research: Argentina, Brazil, Chile, Colombia, Mexico, and Venezuela. Mexico produced the largest number of papers, while Brazil showed a larger number of citations per paper. CONCLUSION: Mental health research is still incipient in Latin American and the Caribbean countries, and many challenges remain to be overcome. Also, it is necessary to establish the research priorities, to allocate more funding, and to improve researchers training in research method and design.

Leading countries in mental health research in Latin America and the Caribbean

OBJECTIVE: The prevalence and burden of mental disorders have been growing in Latin-American and the Caribbean countries and research is an important tool for changing this scenario. The objective of this paper is to describe the development of mental health research in Latin American and the Caribbean countries from 1995 to 2005. METHOD: The indicators of productivity were based on the ISI Essential Science Indicators database. We compared the number of papers and citations, as well as the number of citations per paper between 1995 and 2005 for each country ranked in the Essential Science Indicators. RESULT: Eleven Latin-American countries were ranked in the ISI database and six of them demonstrated a higher level of development in mental health research: Argentina, Brazil, Chile, Colombia, Mexico, and Venezuela. Mexico produced the largest number of papers, while Brazil showed a larger number of citations per paper. CONCLUSION: Mental health research is still incipient in Latin American and the Caribbean countries, and many challenges remain to be overcome. Also, it is necessary to establish the research priorities, to allocate more funding, and to improve researchers training in research method and design.

OBJETIVO: A prevalência e a carga dos transtornos mentais vêm crescendo nos países latino-americanos e a pesquisa tem sido considerada uma importante ferramenta para alterar este cenário. Este estudo descreve o desenvolvimento da pesquisa em saúde mental nos países latino-americanos e Caribe no período de 1995 a 2005. MÉTODO: Foram utilizados os indicadores de produtividade baseados no banco de dados "Essential Science Indicators" do ISI. Foram comparados o número total de artigos e citações e também o número de citações por artigo para cada um dos países classificados no Essential Science Indicators. RESULTADOS: Foram encontrados 11 países latino-americanos e Caribe no ISI, e seis destes apresentaram um maior desenvolvimento em pesquisa em saúde mental: Argentina, Brasil, Chile, Colômbia, México e Venezuela. O México foi o que apresentou o maior número de artigos, enquanto o Brasil apresentou maior número de citações por artigo. CONCLUSÃO: A pesquisa em saúde mental nos países latino-americanos e Caribe ainda é incipiente e muitos desafios necessitam ser superados, como o estabelecimento de prioridades, maior alocação de fundos e aprimoramento do treinamento dos pesquisadores em metodologia e desenhos de pesquisa.

Mental health and psychiatry research in Brazil: scientific production from 1999 to 2003.

OBJECTIVE: To assess the extent of mental health scientific production in Brazil from 1999 to 2003, and to identify the nature of the publications generated, their sources of finance and the ways of publicly disseminating the research findings. METHODS: Searches for publications were conducted in the Medline and PsychInfo databases for the period 1999-2003. A semi-structured questionnaire developed by an international team was applied to 626 mental health researchers, covering each interviewee's educational background, research experience, access to funding sources, public impact and research priorities. The sample was composed by 626 mental health researchers identified from 792 publications indexed on Medline and PsychInfo databases for the period above, and from a list of reviewers of Revista Brasileira de Psiquiatria. RESULTS: In Brazil, 792 publications were produced by 525 authors between 1999 and 2003 (441 indexed in Medline and 398 in the ISI database). The main topics were: depression (29.1%), substance misuse (14.6%), psychoses (10%), childhood disorders (7%) and dementia (6.7%). Among the 626 Brazilian mental health researchers, 329 answered the questionnaire. CONCLUSIONS: There were steadily increasing numbers of Brazilian articles on mental health published in foreign journals from 1999 to 2003: the number of articles in Medline tripled and it doubled in the ISI database. The content of these articles corresponded to the priorities within mental health, but there is a need for better interlinking between researchers and mental health policymakers.

Mental health and psychiatry research in Brazil: scientific production from 1999 to 2003

OBJETIVO: Mapear a produção científica brasileira em saúde mental no período 1999-2003 e identificar a natureza das publicações geradas, suas fontes de financiamento e as formas de divulgação pública dos resultados.MÉTODOS: As buscas dos artigos foram realizadas nas bases de dados do PsychInfo e Medline no período 1999-2003.Um questionário semi-estruturado, desenvolvido por uma equipe internacional, foi aplicado a 626 pesquisadores de saúde mental, abordando-se as seguintes áreas: formação pessoal, experiência em pesquisa, acesso a fontes de financiamento, impacto público e prioridades de pesquisa de cada entrevistado. A amostra foi composta por 626 profissionais de Saúde Mental identificados a partir de 792 publicações indexadas no Medline e PsychInfo, (1999-2003) e também, de uma lista de pareceristas da Revista Brasileira de Psiquiatria.RESULTADOS: Foram recuperadas 792 publicações, produzidas por 525 autores brasileiros no período 1999-2003 (441 indexadas no Medline e 398 na base ISI). Essas publicações abordavam os tópicos: depressão (29,1%), abuso de substâncias (14,6%), psicoses (10%), transtornos da infância (7%) e demência (6,7%). Dos 626 investigadores envolvidos com pesquisa em saúde mental, 329 responderam ao questionário.CONCLUSÕES: Houve um crescimento contínuo da publicação de artigos brasileiros em saúde mental em periódicos internacionais entre 1999 e 2003: o número de artigos na base Medline triplicou e duplicou nas bases ISI. O conteúdo dos artigos corresponde às prioridades da saúde mental, mas é necessário um maior entrosamento entre pesquisadores e tomadores de decisão na política de saúde mental.

Mental health research in Brazil: policies, infrastructure, financing and human resources

O presente estudo, descritivo teve como objetivo mapear a pesquisa em saúde mental no Brasil, fornecendo uma visão de infraestrutura, financiamento e políticas em saúde mental das pesquisas. O estudo faz parte do Projeto Atlas da Organização Mundial da Saúde realizado nos países de média e baixa renda per capita, entre os anos de 1998-2002. A coleta de dados incluiu a avaliação de documentos governamentais e páginas da web, e questionários enviados para os profissionais chave para fornecer informações acerca da infra-estrutura de pesquisa em saúde mental no Brasil. No ano de 2002, o orçamento total para a pesquisa em saúde foi de 101 milhões de dólares, dos quais 3,4 milhões (3,4 por cento) foram aplicados em Pesquisa para Saúde Mental. As principais fontes financiadoras para pesquisa mental foram a Fundação de Amparo à Pesquisa do Estado de São Paulo (Fapesp, 53,2 por cento) e o Ministério da Educação (CAPES, 30,2 por cento). A proporção de doutores é de 1,7 por um mil habitantes, e a taxa de psiquiatras é de 2.7 por 100 mil habitantes, estimadas pelo censo de 2000. Em 2002, havia 53 cursos de pós-graduação direcionados a educação em saúde mental no Brasil (43 em psicologia, seis em psiquiatria, três em psicobiologia e um em enfermagem psiquiátrica, com 1.775 alunos sendo treinados no Brasil e 67 no exterior. Há nove programas dedicados para a psiquiatria, neuropsiquiatria, psicobiologia e saúde mental no País, sete deles localizados na região Sudeste. No período de cinco anos, 186 estudantes receberam o título de doutor (37 por ano) e 637 artigos foram publicados em revistas indexadas no Institute for Scientific Information (ISI). O investimento canalizado para os programas de pós-graduação na formação de recursos humanos, por meio de bolsas de estudos e fomento à pesquisa, tem permitido ao País uma modesta, mas crescente presença na pesquisa em saúde mental no cenário internacional.

Mental health research in Brazil: policies, infrastructure, financing and human resources.

The objective of this descriptive study was to map mental health research in Brazil, providing an overview of infrastructure, financing and policies mental health research. As part of the Atlas-Research Project, a WHO initiative to map mental health research in selected low and middle-income countries, this study was carried out between 1998 and 2002. Data collection strategies included evaluation of governmental documents and sites and questionnaires sent to key professionals for providing information about the Brazilian mental health research infrastructure. In the year 2002, the total budget for Health Research was USD 101 million, of which USD 3.4 million (3.4) was available for Mental Health Research. The main funding sources for mental health research were found to be the São Paulo State Funding Agency (FAPESP, 53.2%) and the Ministry of Education (CAPES, 30.2%). The rate of doctors is 1.7 per 1,000 inhabitants, and the rate of psychiatrists is 2.7 per 100,000 inhabitants estimated 2000 census. In 2002, there were 53 postgraduate courses directed to mental health training in Brazil (43 in psychology, six in psychiatry, three in psychobiology and one in psychiatric nursing), with 1,775 students being trained in Brazil and 67 overseas. There were nine programs including psychiatry, neuropsychiatry, psychobiology and mental health, seven of them implemented in Southern states. During the five-year period, 186 students got a doctoral degree (37 per year) and 637 articles were published in Institute for Scientific Information (ISI)-indexed journals. The investment channeled towards postgraduate and human resource education programs, by means of grants and other forms of research support, has secured the country a modest but continuous insertion in the international knowledge production in the mental health area.