Social support network, mental health and quality of life: a cross-sectional study in primary care.

The objective of this study was to identify the association between emotional distress and social support networks with quality of life in primary care patients. This was a cross-sectional study involving 1,466 patients in the cities of São Paulo and Rio de Janeiro, Brazil, in 2009/2010. The General Health Questionnaire, the Hospital Anxiety and Depression Scale and the brief version of the World Health Organization Quality of Life Instrument were used. The Social Support Network Index classified patients with the highest and lowest index as socially integrated or isolated. A bivariate analysis and four multiple linear regressions were conducted for each quality of life outcome. The means scores for the physical, psychological, social relations, and environment domains were, respectively, 64.7; 64.2; 68.5 and 49.1. In the multivariate analysis, the psychological domain was negatively associated with isolation, whereas the social relations and environment domains were positively associated with integration. Integration and isolation proved to be important factors for those in emotional distress as they minimize or maximize negative effects on quality of life.

The individual contribution and relative importance of self-management and quality of care on glycaemic control in type 2 diabetes.

OBJECTIVE: To evaluate the relative importance of selfmanagement (SM) and quality of care (QoC) inpredicting glycaemic control in patients with type 2 diabetes. MATERIALS AND METHODS: A longitudinal cohort study was conducted in 204 adults diagnosed with type 2 diabetes. Self-management and quality of care were measured at baseline. HbA1c was measured at baseline and at six-month follow-up. RESULTS: None of the measures of self-management were significantly associated with HbA1c.Treatment intensification (TI) (a proxy for quality of care) resulted in lower HbA1c at follow-up. Other variables were associated with HbA1c at follow-up: HbA1c at baseline, age, diabetes duration, and combination of oral glucose-lowering medications. An exploratory analysis showed that patients who did not receive treatment intensification but performed more self-management behaviours had lower HbA1c levels at follow-up. CONCLUSION: Treatment intensification might be more important for glycaemic control than self-management but the interaction between treatment intensification and self-management needs further research.

The individual contribution and relative importance of self-management and quality of care on glycaemic control in type 2 diabetes / Contribución individual e importancia relativa del auto-cuidado y la calidad de la atención en el control glucémico de la diabetes tipo 2

Abstract: Objective: To evaluate the relative importance of selfmanagement (SM) and quality of care (QoC) inpredicting glycaemic control in patients with type 2 diabetes. Materials and methods: A longitudinal cohort study was conducted in 204 adults diagnosed with type 2 diabetes. Self-management and quality of care were measured at baseline. HbA1c was measured at baseline and at six-month follow-up. Results: None of the measures of self-management were significantly associated with HbA1c.Treatment intensification (TI) (a proxy for quality of care) resulted in lower HbA1c at follow-up. Other variables were associated with HbA1c at follow-up: HbA1c at baseline, age, diabetes duration, and combination of oral glucose-lowering medications. An exploratory analysis showed that patients who did not receive treatment intensification but performed more self-management behaviours had lower HbA1c levels at follow-up. Conclusion: Treatment intensification might be more important for glycaemic control than self-management but the interaction between treatment intensification and self-management needs further research.

Resumen: Objetivo: Evaluar la importancia relativa del autocuidado (AU) y calidad de la atención (CA) para predecir control glucémico en diabetes mellitus tipo 2 (DM2). Material y métodos: Estudio longitudinal en 204 adultos con DM2. AU y CA evaluados en la medición basal. HbA1c evaluada en la medición basal y a los seis meses. Resultados: A los seis meses, ninguna de las mediciones de AU se asoció significativamente con HbA1c. La intensificación en el tratamiento (IT) (proxy de CA) se asoció con disminución de HbA1c. Otras variables asociadas con HbA1c: HbA1c en medición basal, edad, duración de diabetes, y combinación de anti-hiperglucemiantes. En un análisis exploratorio, los participantes que no recibieron IT pero desempeñaron más conductas de AU tuvieron niveles más bajos de HbA1c. Conclusión: IT parece ser más importante para el control glucémico que AU, pero la interacción entre IT y conductas de AU se deben estudiar con más profundidad.

Social support network, mental health and quality of life: a cross-sectional study in primary care / Rede de apoio social, saúde mental e qualidade de vida: um estudo transversal na atenção primária / Red de apoyo social, salud mental y calidad de vida: un estudio transversal en la atención primaria

The objective of this study was to identify the association between emotional distress and social support networks with quality of life in primary care patients. This was a cross-sectional study involving 1,466 patients in the cities of São Paulo and Rio de Janeiro, Brazil, in 2009/2010. The General Health Questionnaire, the Hospital Anxiety and Depression Scale and the brief version of the World Health Organization Quality of Life Instrument were used. The Social Support Network Index classified patients with the highest and lowest index as socially integrated or isolated. A bivariate analysis and four multiple linear regressions were conducted for each quality of life outcome. The means scores for the physical, psychological, social relations, and environment domains were, respectively, 64.7; 64.2; 68.5 and 49.1. In the multivariate analysis, the psychological domain was negatively associated with isolation, whereas the social relations and environment domains were positively associated with integration. Integration and isolation proved to be important factors for those in emotional distress as they minimize or maximize negative effects on quality of life.

O estudo teve como objetivo identificar a associação entre sofrimento emocional e redes de apoio social com qualidade de vida em pacientes de atenção primária. O estudo transversal incluiu 1.466 pacientes nas cidades de São Paulo e Rio de Janeiro, Brasil, entre 2009 e 2010. Foram utilizados o General Health Questionnaire, a Hospital Anxiety and Depression Scale e a versão breve do World Health Organization Quality of Life Instrument. O Índice de Redes Sociais de Apoio classificou os pacientes com as pontuações mais altas e baixas como sendo socialmente integrados ou isolados, respectivamente. Para cada resultado de qualidade vida, foram realizadas uma análise bivariada e quatro regressões lineares múltiplas. As médias para os domínios físico, psicológico, social e ambiental foram, respectivamente: 64,7; 64,2; 68,5 e 49,1. Na análise multivariada, o domínio psicológico mostrou associação negativa com o isolamento, enquanto os domínios social e ambiental foram associados positivamente com a integração. A integração e o isolamento apareceram como fatores importantes para aqueles com sofrimento emocional, já que minimizam ou maximizam os efeitos negativos sobre qualidade de vida.

El estudio tuvo como objetivo identificar la asociación entre sufrimiento emocional y redes de apoyo social con la calidad de vida en pacientes de atención primaria. El estudio transversal incluyó a 1.466 pacientes en las ciudades de São Paulo y Río de Janeiro, Brasil, entre 2009 y 2010. Se utilizaron el General Health Questionnaire, la Hospital Anxiety and Depression Scale y la versión breve del World Health Organization Quality of Life Instrument. El Índice de Redes Sociales de Apoyo clasificó a los pacientes con las puntuaciones más altas y bajas como estando socialmente integrados o aislados, respectivamente. Para cada resultado de calidad vida, se realizó un análisis bivariado y cuatro regresiones lineales múltiples. Las medias para los dominios físico, psicológico, social y ambiental fueron, respectivamente: 64,7; 64,2; 68,5 y 49,1. En el análisis multivariado, el dominio psicológico mostró una asociación negativa con el aislamiento, mientras los dominios social y ambiental se asociaron positivamente con la integración. La integración y el aislamiento aparecieron como factores importantes para aquellos con sufrimiento emocional, ya que minimizan o maximizan los efectos negativos sobre la calidad de vida.

Brazilian multicentre study of common mental disorders in primary care: rates and related social and demographic factors.

Mental health problems are common in primary health care, particularly anxiety and depression. This study aims to estimate the prevalence of common mental disorders and their associations with socio-demographic characteristics in primary care in Brazil (Family Health Strategy). It involved a multicenter cross-sectional study with patients from Rio de Janeiro, São Paulo, Fortaleza (Ceará State) and Porto Alegre (Rio Grande do Sul State), assessed using the General Health Questionnaire (GHQ-12) and the Hospital Anxiety and Depression Scale (HAD). The rate of mental disorders in patients from Rio de Janeiro, São Paulo, Fortaleza and Porto Alegre were found to be, respectively, 51.9%, 53.3%, 64.3% and 57.7% with significant differences between Porto Alegre and Fortaleza compared to Rio de Janeiro after adjusting for confounders. Prevalence proportions of mental problems were especially common for females, the unemployed, those with less education and those with lower incomes. In the context of the Brazilian government's moves towards developing primary health care and reorganizing mental health policies it is relevant to consider common mental disorders as a priority alongside other chronic health conditions.

Brazilian multicentre study of common mental disorders in primary care: rates and related social and demographic factors / Estudo multicêntrico brasileiro sobre transtornos mentais comuns na atenção primária: prevalência e fatores sociodemográficos relacionados / Estudio brasileño multicéntrico de trastornos mentales comunes en atención primaria: prevalencia y factores sociodemográficos relacionados

Mental health problems are common in primary health care, particularly anxiety and depression. This study aims to estimate the prevalence of common mental disorders and their associations with socio-demographic characteristics in primary care in Brazil (Family Health Strategy). It involved a multicenter cross-sectional study with patients from Rio de Janeiro, São Paulo, Fortaleza (Ceará State) and Porto Alegre (Rio Grande do Sul State), assessed using the General Health Questionnaire (GHQ-12) and the Hospital Anxiety and Depression Scale (HAD). The rate of mental disorders in patients from Rio de Janeiro, São Paulo, Fortaleza and Porto Alegre were found to be, respectively, 51.9%, 53.3%, 64.3% and 57.7% with significant differences between Porto Alegre and Fortaleza compared to Rio de Janeiro after adjusting for confounders. Prevalence proportions of mental problems were especially common for females, the unemployed, those with less education and those with lower incomes. In the context of the Brazilian government's moves towards developing primary health care and reorganizing mental health policies it is relevant to consider common mental disorders as a priority alongside other chronic health conditions.

Problemas de saúde mental são comuns na atenção primária e são geralmente relacionados à ansiedade e à depressão. Este estudo tem o objetivo de avaliar a taxa de transtornos mentais comuns e suas associações com características sociodemográficas em unidades de saúde da família. É um estudo multicêntrico, transversal, com os usuários da atenção primária do Rio de Janeiro, São Paulo, Fortaleza (Ceará) e Porto Alegre (Rio Grande do Sul), Brasil. Utilizou-se o General Health Questionnaire (GHQ-12) e o Hospital Anxiety and Depression Scale (HAD). A taxa de transtornos mentais nos usuários do Rio de Janeiro, São Paulo, Fortaleza e Porto Alegre foram, respectivamente, 51,9%, 53,3%, 64,3% e 57,7%, com diferenças significativas entre Porto Alegre e Fortaleza comparando-se ao Rio de Janeiro. Problemas de saúde mental foram especialmente altos em mulheres, desempregados, em pessoas com baixa escolaridade e com baixa renda. Dadas as iniciativas do governo brasileiro para o desenvolvimento os cuidados primários e para reorganização da política pública de saúde mental, é importante considerar os transtornos mentais comuns como uma prioridade tal como outras morbidades crônicas.

Los problemas de salud mental son comunes en la atención primaria y están relacionados con la ansiedad y la depresión. Este estudio tiene como objetivo evaluar las tasas de trastornos mentales comunes y sus asociaciones con las características sociodemográficas de los usuarios de la atención primaria. Se trata de un estudio multicéntrico, transversal, con usuarios de Río de Janeiro, São Paulo, Fortaleza y Porto Alegre, Brasil. Se utilizó el General Health Questionnaire (GHQ-12) y el Hospital Anxiety and Depression Scale (HAD). La tasa de trastornos mentales en pacientes de Río de Janeiro, São Paulo, Fortaleza (Ceará) y Porto Alegre (Río Grande do Sul) fueron, respectivamente, 51,9%, 53,3%, 64,3% y 57,7%, con diferencias significativas entre Porto Alegre y Fortaleza. Los problemas de salud mental fueron especialmente altos en las mujeres, desempleados, personas con bajo nivel educativo y quienes tienen bajos ingresos. Teniendo en cuenta los esfuerzos del gobierno brasileño para el desarrollo de la atención primaria y las políticas para la reorganización de la salud mental es importante considerar los trastornos mentales como una prioridad junto a otras afecciones crónicas.

Psychiatric morbidity and quality of life of primary care attenders in two cities in Brazil / Sofrimento psíquico e qualidade de vida em pacientes da atenção primária de duas cidades do Brasil

Objective: To identify the associations among quality of life (QoL), social determinants and psychological distress in primary care in two cities in Brazil. Methods: A cross-sectional study with 1,466 patients from 2009 to 2010. The statistical analysis used the t-test to compare the variables of interest to the study. Results: The prevalence of Common Mental Disorders (CMD3), severe forms of Common Mental Disorders (CMD5), anxiety and depression were 20.5%, 32%, 37% and 25.1% respectively. Thes presence of psychological distress is associated with worse QoL among the patients studied, especially those older than 40 years of age. In cases of CMD3, those with higher income and educational levels presented higher QoL in the psychical and psychological domains. For the cases of probable anxiety, those with higher educational levels presented lower scores on the physical and social relationship scores. Conclusion: Psychological distress can be associated with a worse QoL among those studied and can be influenced by socioeconomic conditions. Therefore, it is important to structure patient-centered help, which should also include patients’ social contexts. .

Objetivo: Identificar as associações entre qualidade de vida (QV), determinantes sociais e sofrimento psíquico na Atenção Primária (AP) em dois municípios do Brasil. Métodos: Estudo transversal com 1.466 pacientes atendidos na AP de São Paulo e Rio de Janeiro nos anos de 2009 e 2010. Resultados: As prevalências de Transtorno Mental Comum (TMC-3), Transtorno Mental Comum de intensidade grave (TMC-5), casos sugestivos de ansiedade e de depressão foram de 20,5%, 32%, 37% e 25,1%, respectivamente. Observou-se a associação entre as variáveis socioeconômicas e a presença de sofrimento psíquico, em especial para aqueles com idade superior a 40 anos. Nos casos de TMC-3, aqueles com maior renda e nível educacional apresentaram maiores escores nos domínios físico e psicológico. Para os casos sugestivos de ansiedade, maior nível educacional apresentou menores escores nos domínios físico e relações sociais. Conclusão: Entre os pesquisados, o sofrimento psíquico associou-se a menores escores de qualidade de vida, podendo ser influenciado pelas condições socioeconômicas. Dessa forma, é importante estruturar uma assistência centrada no paciente, que também deve incluir o contexto social dos pacientes. .

The relationship between quality of care and self-management in patients with type 2 diabetes: a cross-sectional survey in primary care in Mexico.

BACKGROUND: Achieving glycaemic control in diabetes reduces complications and improves outcomes. Glycaemic control requires both good quality clinical care and effective self-management support. However, the relationship between these factors in routine clinical practice is unclear. AIMS: To evaluate baseline levels of self-management and clinical quality of care in patients with type 2 diabetes in primary care in Mexico and to explore relationships between measures of self-management and clinical quality of care. METHODS: The sample consisted of adults (N=205) diagnosed with type 2 diabetes for over a year and registered at one of five practices in the Mexican Institute of Social Security in Aguascalientes. Self-management and quality of care were measured using medical record review and interviews, including validated measures of diabetes knowledge, self-care behaviours, self-efficacy, treatment intensification, continuity of care, doctor-patient communication, and patient satisfaction with diabetes care. HbA1c and cholesterol tests were taken. RESULTS: There were few associations between measures of self-management, and between measures of the quality of clinical care. 'Strong' knowledge about medical prescription was associated with higher diabetes knowledge (OR = 1.2, 95% CI 1.08 to 1.32). Diabetes self-efficacy was associated with self-care behaviours (OR = 1.51, 95% CI 1.26 to 1.81). Patient-doctor communication was associated with continuity of care (Chi-squared = 11.03, P <0.05), with patient satisfaction (ß = 6.17, 95% CI 4.47 to 7.93) and with diabetes self-efficacy (ß = 0.70, 95% CI 0.19 to 1.20, P <0.01). Patient satisfaction was associated with continuity of care (F = 7.82, P <0.001). CONCLUSION: The associations between measures of self-management and quality of care were modest. Patients who were achieving high levels of one aspect of care were not necessarily receiving high levels of the other. This indicates that different factors are likely to be driving each aspect of care and highlights the importance of measuring their relative importance.

Evaluation of a mental health training intervention for multidisciplinary teams in primary care in Brazil: a pre- and posttest study.

OBJECTIVES: The aim of this research was to investigate whether a training intervention to enhance collaboration between mental health and primary care professionals improved the detection and management of mental health problems in primary health care in four large cities in Brazil. The training intervention was a multifaceted program over 96 h focused on development of a shared care model. METHOD: A quasiexperimental study design was undertaken with assessment of performance by nurse and general practitioners (GPs) pre- and postintervention. Rates of recognition of mental health disorders (compared with the General Health Questionnaire) were the primary outcome, while self-reports of patient-centered care, psychosocial interventions and referral were the secondary outcomes. RESULTS: Six to 8 months postintervention, no changes were observed in terms of rate of recognition across the entire sample. Nurses significantly increased their recognition rates (from 23% to 39%, P=.05), while GPs demonstrated a significant decrease (from 42% to 30%, P=.04). There were significant increases in reports of patient-centered care, but no changes in other secondary outcomes. CONCLUSIONS: Training professionals in a shared care model was not associated with consistent improvements in the recognition or management of mental health problems. Although instabilities in the local context may have contributed to the lack of effects, wider changes in the system of care may be required to augment training and encourage reliable changes in behavior, and more specific educating models are necessary.