Telehealth in community mental health centers during the COVID-19 pandemic in Peru: A qualitative study with key stakeholders.

Aim: To describe the perceptions and experiences of key stakeholders to understand the use of telehealth in community mental health centers (CMHCs) during the COVID-19 pandemic in Lima and Callao, Peru. Methods: A qualitative study was carried out in four CMHCs in Lima and Callao, Peru. Forty-nine individual semi-structured interviews were conducted between September 2021 and March 2022, considering CMHCs' users and their relatives, health and administrative workers, directors, as well as local and national policymakers. Data was analyzed using thematic analysis. Results: Regarding the transition from in-person care to telehealth, CMHCs' directors and workers identified some of the regulations issued by the Government during the pandemic, such as the continuity of care through telehealth, especially for pregnant women and for people with comorbidities related to COVID-19. Regarding benefits, workers and users indicated that it allowed better communication, such as constant follow-ups. Directors and workers recognized that Google Drive facilitated access to user information, since they did not have an electronic medical record. Additionally, workers said they used social media to share educational information on mental health, and explained that some new users began their treatment this way. Regarding difficulties, participants reported a lack of devices and poor internet connection in CMHCs. Users mentioned that scheduling an appointment was difficult because the phone lines were usually saturated, and they could not find available appointments. Conclusion: Although the pandemic forced an immediate and disruptive change towards telehealth, CMHCs were able to adapt most of their services. This study reports the adaptations made by CMHCs to move from in-person to remote care, identifying the benefits and challenges faced, information that can be used for the nationwide implementation of telehealth in CMHCs. We recommend ensuring technological equipment and internet connection and adapt the telehealth system to make it responsive to the routine practices of CMHCs.

Experiences of users and family members on the care received at community mental health centers in Lima and Callao during the COVID-19 pandemic. / Experiencias de usuarios y familiares sobre la atención recibida en centros de salud mental comunitaria de Lima y Callao durante la pandemia de la COVID-19.

OBJECTIVE.: To understand the experiences of new and continuing users of Community Mental Health Centers (CMHC) of Lima and Callao, and their relatives, regarding the mental health care they received during the COVID-19 pandemic. MATERIALS AND METHODS.: Qualitative study conducted between September 2021 and February 2022, in which we interviewed 24 users and family members who interacted with the services provided by three CMHCs in Lima and one in Callao during the COVID-19 pandemic. We carried out a thematic analysis of the transcribed interviews. RESULTS.: Participants perceived that the pandemic exacerbated the symptoms of people with mental health problems. During the pandemic, mental health care relied on the use of technology, mainly telephone calls, which were used to monitor the emotional state and pharmacological treatment of users, as well as to schedule and remember appointments. The users emphasized that frequent telephone calls made them feel accompanied and highlighted the commitment of the CMHC workers. Among the difficulties, they reported an increase in the demand for care, problems in accessing video calls, and low quality in virtual care. CONCLUSIONS.: COVID-19 had an emotional impact on people with mental health problems; in turn, CMHC services were affected by the type of care (face-to-face or virtual), resources, frequency, time and quality of care, finding limitations and benefits in the use of technology.

OBJETIVOS.: Comprender las experiencias de usuarios nuevos y continuadores de los Centros de Salud Mental Comunitaria (CSMC) de Lima y Callao, y de sus familiares, en relación a la atención en salud mental que recibieron durante la pandemia de la COVID-19. MATERIALES Y MÉTODOS.: Estudio cualitativo realizado entre septiembre del 2021 y febrero del 2022, en el que se entrevistó a 24 usuarios y familiares que interactuaron con los servicios brindados por tres CSMC de Lima y uno del Callao, durante la pandemia de la COVID-19. Se realizó un análisis temático de las entrevistas transcritas. RESULTADOS.: Los informantes percibieron que la pandemia exacerbó los síntomas de las personas con problemas de salud mental. Durante la pandemia, las atenciones de salud mental se apoyaron en el uso de tecnología, principalmente de llamadas telefónicas, las que sirvieron para monitorear el estado emocional y el tratamiento farmacológico de los usuarios, así como para programar y recordar citas. Los usuarios destacan que las llamadas telefónicas frecuentes les hicieron sentirse acompañados y resaltan el compromiso de los trabajadores de los CSMC. Como dificultades, reportan el incremento en la demanda de atención, problemas para acceder a videollamadas, y menor calidad en las atenciones virtuales. CONCLUSIONES.: La COVID-19 impactó emocionalmente a las personas con problemas de salud mental, a su vez, los servicios de los CSMC vieron afectada la modalidad (presencial o virtual), recursos, frecuencia, tiempo y calidad de la atención, encontrando limitaciones y beneficios en el uso de la tecnología.

The impact of COVID-19 pandemic on the quality of life of healthcare workers and the associated factors: A systematic review.

Introduction: The COVID-19 pandemic has exacerbated health issues in healthcare workers which in turn impacts their quality of life. Objective: This review aimed to (i) analyze the impact of the COVID-19 pandemic on the quality of life of healthcare professionals and (ii) identify the associated factors with quality of life. Materials and methods: We conducted a systematic review using the PRISMA guidelines previously registered in PROSPERO (CRD42021253075). The searched in Web of Science, Scopus, MEDLINE and EMBASE databases included original articles published till May 2021. Results: We found 19 articles and 14,352 professionals in total, the median age ranged from 29 to 42.5 years and 37% of the studies used the WHOQOL-BREF instrument to assess the outcome. The report was heterogeneous, 7 studies described global scores and 9 by domains. Depression, anxiety and stress were commonly reported factors affecting professional's quality of life and this was significantly lower among professionals working with COVID-19 patients compared to their counterparts. Conclusion: COVID-19 frontline workers perceived lower quality of life, which was mainly associated with psychological states such as the aforementioned besides to working conditions like not being previously trained in COVID-19 cases. On the other hand, social support, resilience and active coping could improved their quality of life.

Introducción: La pandemia de COVID-19 ha agravado los problemas de salud del personal sanitario, lo que a su vez repercute en su calidad de vida. Objetivo: Esta revisión tiene como objetivo: (a) Analizar el impacto de la pandemia COVID-19 en la calidad de vida de los profesionales sanitarios y (2) Identificar los factores asociados a su calidad de vida. Materiales y métodos: Se realizó una revisión sistemática utilizando las pautas PRISMA previamente registradas en PROSPERO (CRD42021253075). La búsqueda en las bases de datos Web of Science, Scopus, MEDLINE y EMBASE incluyó artículos originales publicados hasta mayo de 2021. Resultados: Se encontraron 19 artículos y 14.352 profesionales en total, la mediana de edad osciló entre 29 y 42,5 años y el 37% de los estudios utilizaron el instrumento WHOQOL-BREF para evaluar el resultado. El informe fue heterogéneo, 7 estudios describieron puntuaciones globales y 9 por dominios. La depresión, la ansiedad y el estrés fueron los factores comúnmente reportados que afectan a la calidad de vida del profesional, y esta fue significativamente menor entre los profesionales que trabajan con pacientes de COVID-19 en comparación con sus homólogos. Conclusión: Los trabajadores de primera línea de COVID-19 percibieron una menor calidad de vida, que se asoció principalmente a estados psicológicos como los mencionados, además de a condiciones de trabajo como no haber recibido formación previa en casos de COVID-19. Por otro lado, el apoyo social, la resiliencia y el afrontamiento activo mejoraron su calidad de vida.

Using Arts-Based Methodologies to Understand Adolescent and Youth Manifestations, Representations, and Potential Causes of Depression and Anxiety in Low-Income Urban Settings in Peru.

BACKGROUND: Arts-based methodologies can be beneficial to identify different representations of stigmatized topics such as mental health conditions. This study used a theater-based workshop to describe manifestations, representations, and potential causes of depression and anxiety as perceived by adolescents and young adults. METHODS: The theater company Teatro La Plaza conducted three online sessions with a group of adolescents and another with a group of young adults from Lima, Peru. The artistic outputs, which included images, similes, monologues, and narrations, were used to describe the experiences of depression and anxiety symptoms following a content analysis using posteriori categories. RESULTS: Seventeen participants joined the sessions. The artistic outputs showed: physical, behavioral, cognitive, and emotional manifestations of depression and anxiety; a perception that both disorders have a cyclical nature; and an awareness that it is often difficult to notice symptom triggers. The mandatory social isolation due to the COVID-19 pandemic was highlighted as an important symptom trigger, mostly linked to anxiety. CONCLUSIONS: The findings are consistent with the literature, especially with regard to the manifestations, representations, and potential causes that trigger depression and anxiety. Using arts-based methods allowed adolescents and young adults to expand the articulation of their representations of mental disorders.

Factors Associated with Mental Health Outcomes in Hospital Workers during the COVID-19 Pandemic: A Mixed-Methods Study.

BACKGROUND: We investigated some of the factors associated with depression, perceived stress, and anxiety in clinical and nonclinical healthcare workers of two hospitals. METHODS: A mixed-methods approach was used. The sample included clinical (physicians, nurses, and others) and nonclinical (security and cleaning staff) healthcare workers of two tertiary hospitals in Peru. Participants completed an online self-survey. In the qualitative analysis, data were subjected to thematic analysis. RESULTS: We analyzed data from 613 participants, of which 8.6%, 9.0%, and 78.2% had moderate-to-severe anxiety, depression, and perceived stress, respectively. Having a previous mental health problem, being concerned about losing one's job, having at least two COVID-19 symptoms in the preceding two weeks, and being afraid of infecting family members increased the prevalence of experiencing moderate-to-severe depression and anxiety. The qualitative analysis allowed us to identify five recurring factors that caused a negative impact on workers' lives during the pandemic: emotional distress linked to hospital experiences of suffering and death, modification of routines, fear of COVID-19, exacerbation of mental disorders, and physical problems associated with emotional distress. CONCLUSIONS: Clinical and nonclinical healthcare workers in Peru have experienced depression, anxiety, and stress during the COVID-19 pandemic. Future research and interventions are necessary to improve psychological support for hospital workers.

Depression, post-traumatic stress, anxiety, and fear of COVID-19 in the general population and health-care workers: prevalence, relationship, and explicative model in Peru.

BACKGROUND: This study has two aims. First, determine the fit of the fear model to COVID-19, anxiety, and post-traumatic stress in the general population and health-care workers. Second, determine which model best explains the relationship between depression and the triad of fear, anxiety, and post-traumatic stress in both groups. METHOD: A cross-sectional study was conducted using self-reported questionnaires for anxiety, fear of COVID-19, depression, and post-traumatic stress. Information was collected from adults living in Lima, the capital and the most populous city in Peru. The explanatory models were evaluated using a structural equation model. RESULTS: A total of 830 participants were included, including general population (n = 640) and health-care workers (n = 190). A high overall prevalence of depressive symptoms (16%), anxiety (11.7%), and post-traumatic stress (14.9%) were identified. A higher prevalence of depressive, anxious, or stress symptoms was identified in the general population (28.6%) compared to health-care workers (17.9%). The triad model of fear of COVID-19, anxiety, and stress presented adequate goodness-of-fit indices for both groups. A model was identified that manages to explain depressive symptoms in more than 70% of the general population and health-care workers, based on the variables of the triad (CFI = 0.94; TLI = 0.94; RMSEA = 0.06; SRMR = 0.06). In the general population post-traumatic stress mediated the relationship between anxiety and depression (ß = 0.12; 95%CI = 0.06 to 0.18) which was significant, but the indirect effect of post-traumatic stress was not significant in health care workers (ß = 0.03; 95%CI = - 0.11 to 0.19). LIMITATIONS: The prevalence estimates relied on self-reported information. Other variables of interest, such as intolerance to uncertainty or income level, could not be evaluated. CONCLUSIONS: Our study proposes and tests one model that explains more than 70% of depressive symptoms. This explanatory model can be used in health contexts and populations to determine how emotional factors can affect depressive symptoms.

[Social and family factors associated with quality of life in children in schools from Piura, Peru]. / Factores sociofamiliares asociados a la calidad de vida en niños de colegios de la ciudad de Piura, Perú.

To determine the socio-familial factors associated with quality of life within the family in children of schools in Piura, Peru. SUBJECTS AND METHOD: A cross-sectional study in a convenience sample of children between 3 to 6 years in schools in the city of Piura, Perú. The quality of life was measured by the HOME test, with data adjusted to the Machover and Koppitz test, and were also associated with other social and family variables. P values were obtained by generalised linear models, adjusting for the residence of each subject. RESULTS: Of the 431 respondents, 64% (275) were male. The median age was 4 years old. A poor quality of life was observed in 50% of children. Traits of violence (p < .001) and aggression (p < .001) were associated to higher frequencies of poor quality of life, adjusted for shyness, dependence, and immaturity. The perception of parent’s love (p = .005), living with both parents (p < .001), playing with someone at home (p = .036), the person with whom plays most is the mother (p = .003) or both parents (p = .004) were associated with the quality of life in the survey. CONCLUSIONS: A large percentage of children who had a poor quality of life was found. The social and family protective factors were to live with both parents, and the demonstration of affection between both parents and play with both.

Factores sociofamiliares asociados a la calidad de vida en niños de colegios de la ciudad de Piura, Perú / Social and family factors associated with quality of life in children in schools from Piura, Peru

Determinar los factores sociofamiliares asociados a la calidad del ambiente en niños de los colegios de Piura, Perú. SUJETOS Y MÉTODOS: Estudio analítico transversal en una muestra por conveniencia de niños entre 3 y 6 años de los colegios de la ciudad de Piura. Se midió la calidad de vida mediante el test HOME, ajustado a los datos del test de Machover y Koppitz; se asociaron otras variables sociofamiliares. Se obtuvieron los valores p mediante modelos lineales generalizados, ajustados por la sede de cada encuestado. RESULTADOS: De los 431 encuestados, el 64% (275) fueron hombres, con una mediana de edad de 4 años. La mala calidad de vida en los niños fue de 50%. Los rasgos de violencia (p < 0,001) y agresividad (p < 0,001) estuvieron asociados con una mayor frecuencia a mala calidad de vida, ajustado por la timidez, dependencia e inmadurez. La percepción que sus papás le quieren (p = 0,005), el vivir con ambos padres (p < 0,001), el que se juegue con alguien en casa (p = 0,036), que la persona con quien más juegue sea la madre (p = 0,003) o ambos padres (p = 0,004) estuvieron asociados a la calidad de vida en los niños encuestados. CONCLUSIONES: Se encontró un gran porcentaje de niños con mala calidad de vida. Los factores sociofamiliares protectores de la calidad de vida son la convivencia con ambos padres, la demostración de que ambos padres se quieren y el juego con ambos.

To determine the socio-familial factors associated with quality of life within the family in children of schools in Piura, Peru. SUBJECTS AND METHOD: A cross-sectional study in a convenience sample of children between 3 to 6 years in schools in the city of Piura, Perú. The quality of life was measured by the HOME test, with data adjusted to the Machover and Koppitz test, and were also associated with other social and family variables. P values were obtained by generalised linear models, adjusting for the residence of each subject. RESULTS: Of the 431 respondents, 64% (275) were male. The median age was 4 years old. A poor quality of life was observed in 50% of children. Traits of violence (p < .001) and aggression (p < .001) were associated to higher frequencies of poor quality of life, adjusted for shyness, dependence, and immaturity. The perception of parent's love (p = .005), living with both parents (p < .001), playing with someone at home (p = .036), the person with whom plays most is the mother (p = .003) or both parents (p = .004) were associated with the quality of life in the survey. CONCLUSIONS: A large percentage of children who had a poor quality of life was found. The social and family protective factors were to live with both parents, and the demonstration of affection between both parents and play with both.