Mental health help-seeking among Brazilian medical students: Who suffers unassisted?

INTRODUCTION: Several barriers for mental health help-seeking were identified among medical students, including minimizing mental illness. Studies examining aspects particular to those who perceive psychological impairment but do not access treatment are necessary for planning interventions. AIMS: To identify help-seeking barriers based on the students' perception about their need for treatment and psychiatric symptoms. Methods: Cross-sectional study assessing 436 Brazilian medical students (833 attending the medical school = 52.3% response rate). Data collection covered sociodemographic data, mental health, academic environment, and Beck Inventories of Depression (BDI) and Anxiety (BAI). Non-parametric tests and hierarchical logistic regression were used to compare students undergoing treatment, those willing to access treatment, and the ones reporting no need for treatment. RESULTS: Among the 382 students who completed the survey (87.6% completion rate), 38.5% (n = 147) were in treatment, and 33% (n = 126) were in need. Moderate to severe risk of alcohol abuse was observed in 45.9% (n = 50) of students reporting no need for treatment. Regression models suggested that perceiving need for treatment - whether already undergoing it or not - was associated with the severity of depressive symptoms (OR 1.14 [95% CI 1.07-1.21]), female assigned sex (OR 2.18 [95% CI 1.23-3.88]), LGBTQ+ (OR 2.47 [95% CI 1.09-5.60]) and reporting good relationship with the family (OR 0.26 [95% CI 0.08-0.83]). Models comparing students in treatment and those in need, pointed that the factors associated with lacking mental health care were age (OR 0.90 [95% CI 0.82-0.99]), perception of a heavy workload (OR 2.43 [95% CI 1.35-4.38]) and good relationship with colleagues (OR 3.51 [95% CI 1.81-6.81]). DISCUSSION: Social variables and the severity of depressive symptoms are positively associated with perceived need for treatment. Age and academic environment factors were related to help-seeking behavior among students with appropriate self-awareness. We discuss these findings' implications for planning interventions.

Aspectos do luto em familiares de mortos em decorrência da Covid-19 / Aspects of grief in family members of the dead as a result of Covid-19

A pandemia de Covid-19 tem gerado efeitos nocivos na saúde mental da população. Isso pode ser especialmente preocupante em pessoas que perderam familiares em decorrência da doença. Este estudo teve como objetivo compreender as particularidades do processo de luto diante da crise ocasionada pela Covid-19. Trata-se de uma pesquisa documental qualitativa que analisou reportagens publicadas entre março e abril de 2020 - período posterior a primeira morte registrada no Brasil - em cinco mídias de grande circulação. Os materiais foram selecionados por dois pesquisadores, e a análise de conteúdo foi realizada pelo método de Bardin. Cinco categorias de análise foram identificadas: Desafios de uma experiência nova e urgente, preconceito decorrente do contato com doentes, sentimentos, formas de enfrentamento e rituais funerários. Manifestações de revolta diante da minimização da doença por autoridades foram frequentes, bem como queixas relacionadas a organização do sistema de saúde, inexistência de fluxos e desinformação dos profissionais. Diante da disseminação de Fake News, foram observados relatos de hostilizações em redes sociais e o afastamento de pessoas conhecidas, gerando solidão. O medo de estar contaminado e de transmitir para outras pessoas também foi recorrente. Ainda, notou-se que a impossibilidade de acompanhar o familiar morto durante a internação e as limitações dos rituais foram associados a culpa e tristeza. É possível que a experiência do luto seja intensificada diante das peculiaridades que permeiam o processo de morte decorrente da Covid-19, sobretudo nos primeiros meses da pandemia. Tendo em vista que os efeitos na saúde mental da população podem ser mais duradouros do que a pandemia, é fundamental que investigações sejam realizadas e estratégias de suporte desenvolvidas.(AU)

The Covid-19 pandemic has had harmful effects on the populations mental health. This can be worrisome in people who have lost family members to Covid-19. This study aims to understand the particularities of the mourning process during the crisis caused by Covid-19. This is a qualitative documentary research that analyzed reports published between March and April 2020 - a period after the first recorded death in Brazil - in five large-circulation media. The materials were selected by two researchers, and content analysis was performed using the Bardin method. Five categories of analysis were identified: Challenges of a new and urgent experience, prejudice resulting from contact with patients, feelings, forms of confrontation and funeral rituals. Manifestations of anger at the authorities minimization of the disease were frequent, as well as complaints related to the organization of the health system, lack of flows and lack of information from professionals. Faced with the spread of Fake News, reports of harassment on social networks and the removal of known people were observed, generating loneliness. The fear of being contaminated and of transmitting it to other people was also recurrent. Furthermore, it was noted that the impossibility of accompanying the deceased family member during hospitalization and the limitations of the rituals were associated with guilt and sadness. It is possible that the experience of grief is intensified given the peculiarities that permeate the process of death resulting from Covid-19, especially in the first months of the pandemic. Considering that the effects on the populations mental health can be more lasting than the pandemic, it is essential that investigations are carried out and support strategies developed.(AU)

La pandemia de Covid-19 ha tenido efectos nocivos en la salud mental de la población. Esto puede ser preocupante en personas que han perdido a familiares a causa de Covid-19. Este estudio tuvo como objetivo comprender las particularidades del proceso de duelo ante la crisis provocada por el Covid-19. Se trata de uma investigación documental cualitativa que analizó informes publicados entre marzo y abril de 2020, un período posterior a la primera muerte registrada en Brasil. Los materiales fueron seleccionados y el análisis de contenido se realizó mediante el método Bardin. Se identificaron cinco categorías de análisis: Desafíos de una experiência nueva y urgente, Prejuicios derivados del contacto con los pacientes, Sentimientos, Formas de enfrentamiento y Ritos funerarios. Fueron frecuentes las manifestaciones de enfado por la minimización de la enfermedad por las autoridades, así como las quejas relacionadas con el sistema de salud, la falta de flujos y la falta de información por parte de los profesionales. Ante la difusión de Fake News, se observaron denuncias de hostigamiento en redes sociales y el alejamiento de personas conocidas, generando soledad. Además, se observó que la imposibilidad de acompañar al familiar fallecido durante la hospitalización y las limitaciones de los rituales se asociaron con la culpa y la tristeza. Es posible que la experiencia del duelo se intensifique dadas las peculiaridades que permean el proceso de muerte resultante del Covid-19, especialmente en los primeros meses de la pandemia. Considerando que los efectos en la salud mental de la población pueden ser más duraderos que la pandemia, es fundamental que se realicen investigaciones y se desarrollen estrategias de apoyo.(AU)

Abordagens de Psicoterapia para Pessoas com Deficiência: Revisão da Literatura / Psychotherapy Approaches for People with Disabilities: Literature Review

RESUMO: Quinze por cento da população mundial apresenta algum tipo de deficiência. Isso pode ser caracterizado por vários tipos de condições, cada uma com sua complexidade específica. Assim sendo, esta revisão da literatura objetiva identificar recentes estudos científicos, no quinquênio 2014-2019, que descrevem cuidados psicoterapêuticos com pessoas com deficiência. Foram consultados: PubMed, EMBASE, Web of Science, PsycINFO (APA), BVS (Bireme/LILACS) e SciELO. Encontrou-se um total de 1.330 artigos. Após dois processos de seleção, 26 pesquisas corresponderam aos critérios de inclusão. A metodologia de pesquisa predominante foi ensaio clínico randomizado, seguido por estudos de caso e estudos descritivos/qualitativos. Pessoas com deficiência intelectual e/ou física, deficiência visual e/ou auditiva e autismo foram as populações mais estudadas. As técnicas comportamentais prevalecem nos estudos incluídos, com menor incidência de técnicas psicodinâmicas. A psicoterapia favorece inclusive o enfrentamento de situações adversas impostas na vida de qualquer ser humano. Pessoas com deficiência também podem apresentar necessidades psicoterápicas, uma vez que, na realidade de suas vidas, incluem complexidades além de sua deficiência. Existem fortes evidências para o uso da psicoterapia como recurso eficaz para a elaboração terapêutica de problemas relacionados à saúde, à educação e à vida social de pessoas com deficiência, independentemente do tipo de intervenção psicoterápica.

ABSTRACT: Fifteen percent of the world's population has some form of disability. This can be characterized by several types of conditions, each with its specific complexity. Thus, this literature review aims to identify recent scientific studies, in the 2014-2019 five-year period, which describe psychotherapeutic care for people with disabilities. PubMed, EMBASE, Web of Science, PsycINFO (APA), BVS (Bireme/LILACS) and SciELO were consulted. It was found a total of 1,330 articles. After two selection processes, 26 research met the inclusion criteria. The predominant research methodology was the randomized clinical trial, followed by case studies and descriptive/qualitative studies. People with intellectual and/or physical disabilities, visual and/or hearing disabilities and autism were the most studied populations. Behavioral techniques prevail in the studies included, with a lower incidence of psychodynamic techniques. Psychotherapy also favors coping with adverse situations imposed on the life of any human being. People with disabilities may also have psychotherapeutic needs, since, in the reality of their lives, they also include complexities in addition to their disability. There is strong evidence for the use of psychotherapy as an effective resource for the therapeutic elaboration of problems related to health, education and social life of people with disabilities, regardless of the type of psychotherapeutic intervention.

Challenges associated with drunk driving measurement: combining police and self-reported data to estimate an accurate prevalence in Brazil.

BACKGROUND: Drunk driving is an important risk factor for road traffic crashes, injuries and deaths. After June 2008, all drivers in Brazil were subject to a "Zero Tolerance Law" with a set breath alcohol concentration of 0.1 mg/L of air. However, a loophole in this law enabled drivers to refuse breath or blood alcohol testing as it may self-incriminate. The reported prevalence of drunk driving is therefore likely a gross underestimate in many cities. OBJECTIVE: To compare the prevalence of drunk driving gathered from police reports to the prevalence gathered from self-reported questionnaires administered at police sobriety roadblocks in two Brazilian capital cities, and to estimate a more accurate prevalence of drunk driving utilizing three correction techniques based upon information from those questionnaires. METHODS: In August 2011 and January-February 2012, researchers from the Centre for Drug and Alcohol Research at the Universidade Federal do Rio Grande do Sul administered a roadside interview on drunk driving practices to 805 voluntary participants in the Brazilian capital cities of Palmas and Teresina. Three techniques which include measures such as the number of persons reporting alcohol consumption in the last six hours but who had refused breath testing were used to estimate the prevalence of drunk driving. RESULTS: The prevalence of persons testing positive for alcohol on their breath was 8.8% and 5.0% in Palmas and Teresina respectively. Utilizing a correction technique we calculated that a more accurate prevalence in these sites may be as high as 28.2% and 28.7%. In both cities, about 60% of drivers who self-reported having drank within six hours of being stopped by the police either refused to perform breathalyser testing; fled the sobriety roadblock; or were not offered the test, compared to about 30% of drivers that said they had not been drinking. DISCUSSION: Despite the reduction of the legal limit for drunk driving stipulated by the "Zero Tolerance Law," loopholes in the legislation permit many drivers under the influence of alcohol to act with impunity. In this context the police/traffic officers are often powerless to enforce the law and thus drunk driving continues to go unchecked. CONCLUSION: Strong legislation and effective enforcement are necessary to reduce the prevalence of this dangerous behaviour. Correction techniques allow calculation of a truer prevalence of drunk driving, which can assist police and policymakers alike to redirect resources and align strategies.