Exploring discrimination and racism in healthcare: a qualitative phenomenology study of Dutch persons with migration backgrounds.

OBJECTIVE: To explore and characterise the discrimination and racism experienced in healthcare from the perspective of Dutch patients with a migration background. DESIGN: This was a qualitative phenomenological study incorporating an inductive thematic analysis of the answers provided to a free form online survey. Descriptive and differential analyses were conducted for the closed-ended questions. SETTING: This study used an online survey distributed in Dutch about experiences of discrimination and racism in healthcare to the general population in the Netherlands. PARTICIPANTS: The survey was completed by 188 participants (Mage=39.89, SDage=10.2). Of whom 80 (Mage=37.92, SDage=10.87) met the eligibility criteria for thematic analysis (ie, has a migration background or a relative with a migration background and experienced discrimination in healthcare based on their background) and were thus included in the analysis. RESULTS: From the total sample, women, relative to men, were 2.31 times more likely to report experiencing healthcare discrimination (OR=2.31; 95% CI 1.23 to 4.37). The majority of the participants (60.1%) had a Moroccan or Turkish background. Six themes were identified relating to experienced discrimination in healthcare based on one's migration background: (1) explicit discrimination, (2) prejudice, (3) not being taken seriously, (4) discriminatory behaviour, (5) language barriers and (6) pain attribution to cultural background. Some participants reported that their attire or religion was linked to their migration background, thus contributing to their experiences of discrimination. CONCLUSION: Dutch patients with a migration background may experience discrimination based on their ethnic identity or other factors related to their backgrounds, such as their faith, culture and skin colour. Discrimination manifests as intersectional and may take different forms (eg, discrimination based on the intersection between race and gender). Therefore, healthcare discrimination may increase health inequities and lead to unequal access to healthcare services. Implicitly or explicitly discriminating against patients is immoral, unethical, illegal and hazardous for individual and public health. Further research on the magnitude of discrimination in healthcare and its relation to health is needed.

Historical narratives about the COVID-19 pandemic are motivationally biased.

How people recall the SARS-CoV-2 pandemic is likely to prove crucial in future societal debates on pandemic preparedness and appropriate political action. Beyond simple forgetting, previous research suggests that recall may be distorted by strong motivations and anchoring perceptions on the current situation1-6. Here, using 4 studies across 11 countries (total n = 10,776), we show that recall of perceived risk, trust in institutions and protective behaviours depended strongly on current evaluations. Although both vaccinated and unvaccinated individuals were affected by this bias, people who identified strongly with their vaccination status-whether vaccinated or unvaccinated-tended to exhibit greater and, notably, opposite distortions of recall. Biased recall was not reduced by providing information about common recall errors or small monetary incentives for accurate recall, but was partially reduced by high incentives. Thus, it seems that motivation and identity influence the direction in which the recall of the past is distorted. Biased recall was further related to the evaluation of past political action and future behavioural intent, including adhering to regulations during a future pandemic or punishing politicians and scientists. Together, the findings indicate that historical narratives about the COVID-19 pandemic are motivationally biased, sustain societal polarization and affect preparation for future pandemics. Consequently, future measures must look beyond immediate public-health implications to the longer-term consequences for societal cohesion and trust.

Workplace Harassment, Cyber Incivility, and Climate in Academic Medicine.

Importance: The culture of academic medicine may foster mistreatment that disproportionately affects individuals who have been marginalized within a given society (minoritized groups) and compromises workforce vitality. Existing research has been limited by a lack of comprehensive, validated measures, low response rates, and narrow samples as well as comparisons limited to the binary gender categories of male or female assigned at birth (cisgender). Objective: To evaluate academic medical culture, faculty mental health, and their relationship. Design, Setting, and Participants: A total of 830 faculty members in the US received National Institutes of Health career development awards from 2006-2009, remained in academia, and responded to a 2021 survey that had a response rate of 64%. Experiences were compared by gender, race and ethnicity (using the categories of Asian, underrepresented in medicine [defined as race and ethnicity other than Asian or non-Hispanic White], and White), and lesbian, gay, bisexual, transgender, queer (LGBTQ+) status. Multivariable models were used to explore associations between experiences of culture (climate, sexual harassment, and cyber incivility) with mental health. Exposures: Minoritized identity based on gender, race and ethnicity, and LGBTQ+ status. Main Outcomes and Measures: Three aspects of culture were measured as the primary outcomes: organizational climate, sexual harassment, and cyber incivility using previously developed instruments. The 5-item Mental Health Inventory (scored from 0 to 100 points with higher values indicating better mental health) was used to evaluate the secondary outcome of mental health. Results: Of the 830 faculty members, there were 422 men, 385 women, 2 in nonbinary gender category, and 21 who did not identify gender; there were 169 Asian respondents, 66 respondents underrepresented in medicine, 572 White respondents, and 23 respondents who did not report their race and ethnicity; and there were 774 respondents who identified as cisgender and heterosexual, 31 as having LGBTQ+ status, and 25 who did not identify status. Women rated general climate (5-point scale) more negatively than men (mean, 3.68 [95% CI, 3.59-3.77] vs 3.96 [95% CI, 3.88-4.04], respectively, P < .001). Diversity climate ratings differed significantly by gender (mean, 3.72 [95% CI, 3.64-3.80] for women vs 4.16 [95% CI, 4.09-4.23] for men, P < .001) and by race and ethnicity (mean, 4.0 [95% CI, 3.88-4.12] for Asian respondents, 3.71 [95% CI, 3.50-3.92] for respondents underrepresented in medicine, and 3.96 [95% CI, 3.90-4.02] for White respondents, P = .04). Women were more likely than men to report experiencing gender harassment (sexist remarks and crude behaviors) (71.9% [95% CI, 67.1%-76.4%] vs 44.9% [95% CI, 40.1%-49.8%], respectively, P < .001). Respondents with LGBTQ+ status were more likely to report experiencing sexual harassment than cisgender and heterosexual respondents when using social media professionally (13.3% [95% CI, 1.7%-40.5%] vs 2.5% [95% CI, 1.2%-4.6%], respectively, P = .01). Each of the 3 aspects of culture and gender were significantly associated with the secondary outcome of mental health in the multivariable analysis. Conclusions and Relevance: High rates of sexual harassment, cyber incivility, and negative organizational climate exist in academic medicine, disproportionately affecting minoritized groups and affecting mental health. Ongoing efforts to transform culture are necessary.

Monoracials' perceptions of biracials in Singapore.

OBJECTIVES: Drawing on social identity theory, present research examined the effects of overlapping racial membership on monoracials' categorization of biracials as in-/out-group members, as well as its impact on monoracials' social perceptions of biracials in Singapore. Within Singapore, it is hypothesized that biracials who share racial membership with monoracials would be rated more as monoracials' racial in-group and be evaluated more positively. Furthermore, monoracials' positive perceptions of biracials with (vs. without) shared racial membership would be less influenced by biracials' confrontation of racial prejudice. METHOD: Studies 1 (N = 242) and 2 (N = 153) sampled Chinese Singaporeans to assess their perceptions of several fictitious biracial targets. Utilizing an experimental confrontation paradigm, Studies 3 (N = 170) and 4 (N = 225) investigated the effects of confronting racial prejudice on Chinese Singaporeans' perceptions of biracials. RESULTS: Studies 1 and 2 revealed that Chinese Singaporeans perceive Chinese-other (vs. non-Chinese) biracials as more racially similar to themselves and were more likely to report positive social perceptions of Chinese-other biracials. Compared to non-Chinese biracials, Studies 3 and 4 found that Chinese-other biracials' response to racial prejudice did not negatively affect Chinese Singaporeans' perception of them. Findings revealed that Chinese-other biracials were well-liked regardless of their response to racial prejudice, demonstrating Chinese Singaporeans' recognition of shared racial membership. Interestingly, Chinese Singaporeans increased their liking for Indian-Malay biracials when they confronted antimajority racial prejudice. CONCLUSION: Perceiving shared racial membership positively influenced Chinese Singaporeans' perceptions and feelings toward biracials. Theoretical and practical implications are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Users choose to engage with more partisan news than they are exposed to on Google Search.

If popular online platforms systematically expose their users to partisan and unreliable news, they could potentially contribute to societal issues such as rising political polarization1,2. This concern is central to the 'echo chamber'3-5 and 'filter bubble'6,7 debates, which critique the roles that user choice and algorithmic curation play in guiding users to different online information sources8-10. These roles can be measured as exposure, defined as the URLs shown to users by online platforms, and engagement, defined as the URLs selected by users. However, owing to the challenges of obtaining ecologically valid exposure data-what real users were shown during their typical platform use-research in this vein typically relies on engagement data4,8,11-16 or estimates of hypothetical exposure17-23. Studies involving ecological exposure have therefore been rare, and largely limited to social media platforms7,24, leaving open questions about web search engines. To address these gaps, we conducted a two-wave study pairing surveys with ecologically valid measures of both exposure and engagement on Google Search during the 2018 and 2020 US elections. In both waves, we found more identity-congruent and unreliable news sources in participants' engagement choices, both within Google Search and overall, than they were exposed to in their Google Search results. These results indicate that exposure to and engagement with partisan or unreliable news on Google Search are driven not primarily by algorithmic curation but by users' own choices.

Weight bias internalization among adolescents in Spain: psychological correlates across gender diversity and weight status / La internalización de los prejuicios de peso entre los y las adolescentes en España: correlatos psicológicos en función del género y el estatus de peso

Weight bias internalization refers to the negative weight-related attributions applied to oneself, but it does not just occur in the highest weight statuses, but rather exists across the entire weight spectrum. There is a negative impact associated to increase psychological problems in adults, however, it has been less studied among the adolescent Spanish population. In this study, we assess the relationship between the internalization of weight bias, social attitudes towards appearance, body appreciation and self-esteem, and potential differences regarding gender and weight status. A community sample of 1258 Spanish adolescents between 12 and 18 years old (46.3% male gender; Mage = 15.58; SD = 1.59; 49.5% female gender; Mage = 15.59; SD = 1.67; and 4.1% non-binary gender; Mage = 14.86; SD = 2.86) participated in the study. The Modified Weight Bias Internalization Scale (WBIS-M), the Rosenberg Self-Esteem Scale (RSES), and the Sociocultural Attitudes Towards Appearance Questionnaire (SATAQ-4) were used. ANOVA’s test and bivariate correlations were performed. The results suggest that females (t = -.55; p ≤ .001) and non-binary adolescents (t = .64; p ≤ .01) have higher levels of WBI-M compared to males. Regarding weight status, the group with obesity (t = 1.39; p ≤ .001) and the group with overweight (t = -.81; p ≤ .001) have higher levels of WBI-M compared to the normal weight group. Significant correlations between WBI-M and the assessed psychological variables were found in the total sample, and across all-gender and weight categories, except for the underweight group. These results are a first approximation to the internalization of weight bias in a Spanish adolescent sample and highlight the need to introduce this concept in prevention and psychological interventions in school context. (AU)

La internalización de los prejuicios de peso hace referencia a las atribuciones negativas relacionadas con el peso aplicadas a uno mismo/a, lo cual no ocurre únicamente en las personas con un estatus de peso elevado, sino en todo el rango de pesos. En adultos, existe evidencia de su impacto negativoasociados a incrementar problemas psicológicos; aunque se ha estudiado en menor medida en la población adolescente. El objetivo de este estudio fue examinar la relación entre la internalización de prejuicios de peso, las actitudes socioculturales hacia la apariencia, la apreciación corporal y el nivel de autoestima, y analizar las posibles diferencias en función del género y del estatus de peso. Participaron 1.258 adolescentes españoles de una muestra comunitaria entre 12 y 18 años (46.3% género masculino; Medad = 15.58; DT = 1.59; 49,5% género femenino; Medad = 15.59; DT = 1.67; y 4.1% género no binario; Medad = 14.86; DT = 2.86). Se utilizaron la escala de internalización de prejuicios de peso modificado (WBIS-M), la escala de autoestima de Rosenberg (RSES) y el cuestionario de actitudes socioculturales hacia la apariencia (SATAQ-4). Se realizó la prueba ANOVA y correlaciones bivariadas. Los resultados sugieren que el grupo identificado con el género femenino (t = -.55; p ≤ .001) y con el no binario (t = .64; p ≤ .01) muestran niveles más altos de internalización del sesgo de peso en comparación con el género masculino. En cuanto al estado ponderal, el grupo con obesidad (t = 1.39; p ≤ .001) y el grupo con sobrepeso (t = -.81; p ≤ .001) presentan niveles más altos de internalización de prejuicios de peso en comparación con el grupo con normopeso. Se encontraron correlaciones significativas entre las puntuaciones del WBIS-M y las variables psicológicas evaluadas en la muestra total yen todas las categorías de género y peso, con la excepción del grupo de bajo peso. (AU)

Social impression formation and depression: examining cognitive flexibility and bias.

Depression is associated with a bias toward negative interpretations of social situations and resistance to integrating evidence consistent with positive interpretations. These features could contribute to social isolation by generating negative expected value for future social interactions. The present study examined potential associations between depressive symptoms and positive (i.e. trust and liking) and negative (i.e. distrust and disliking) social impression formation of individuals who previously appeared in positive or negative contexts. Participants (N = 213) completed the Interpretation Inflexibility Task and were subsequently asked to provide social impression ratings of characters from each scenario type of the task (i.e. positive and negative) as well as characters not previously encountered. In examining social impression formation, higher severity of depressive symptoms was associated with higher negative social impression ratings regardless of scenario outcome, as well as lower positive social impression ratings, but only for characters who previously appeared in positive contexts. Those higher in depression also rated novel characters as significantly more unlikeable and untrustworthy and to an equivalent degree as the characters previously encountered. These findings suggest a role of negative interpretation bias and inflexibility in contributing to negative evaluations of potential social interaction partners in depression.

The Binary Order of Things: A Discursive Study of Nursing Students' Talk on Providing, and Learning About, LGBT Patient Care.

Against the backdrop of the healthcare inequities and maltreatment facing LGBT patients, recommendations have been made for the inclusion of LGBT health topics in nursing curricula. Based on data collected in focus group discussions with South African nursing students, we complicate the assumption that training focused on health-specific knowledge will effectively reform providers' prejudicial practices. Findings reveal ambivalence: silence and discrimination versus inclusive humanism. Participants drew on discourses of ignorance, religion, and egalitarian treatment to justify their inadequacy regarding LGBT patients; while doing so, however, they deployed othering discourses in which homophobic and transphobic disregard is rendered acceptable, and "scientifically" supported through binary, deterministic views of sexuality and gender. Such "expert" views accord with Foucault's notion of "grotesque discourse." We conclude with a discussion of the findings' implications for nursing education; we call for the recognition and teaching of binary ideology as a form of discursive violence over LGBT lives.

Discriminatory attitudes against unvaccinated people during the pandemic.

During the COVID-19 pandemic, sizeable groups of unvaccinated people persist even in countries with high vaccine access1. As a consequence, vaccination became a controversial subject of debate and even protest2. Here we assess whether people express discriminatory attitudes in the form of negative affectivity, stereotypes and exclusionary attitudes in family and political settings across groups defined by COVID-19 vaccination status. We quantify discriminatory attitudes between vaccinated and unvaccinated citizens in 21 countries, covering a diverse set of cultures across the world. Across three conjoined experimental studies (n = 15,233), we demonstrate that vaccinated people express discriminatory attitudes towards unvaccinated individuals at a level as high as discriminatory attitudes that are commonly aimed at immigrant and minority populations3-5. By contrast, there is an absence of evidence that unvaccinated individuals display discriminatory attitudes towards vaccinated people, except for the presence of negative affectivity in Germany and the USA. We find evidence in support of discriminatory attitudes against unvaccinated individuals in all countries except for Hungary and Romania, and find that discriminatory attitudes are more strongly expressed in cultures with stronger cooperative norms. Previous research on the psychology of cooperation has shown that individuals react negatively against perceived 'free-riders'6,7, including in the domain of vaccinations8,9. Consistent with this, we find that contributors to the public good of epidemic control (that is, vaccinated individuals) react with discriminatory attitudes towards perceived free-riders (that is, unvaccinated individuals). National leaders and vaccinated members of the public appealed to moral obligations to increase COVID-19 vaccine uptake10,11, but our findings suggest that discriminatory attitudes-including support for the removal of fundamental rights-simultaneously emerged.

Evidências de validade da Escala de Orientação à Dominância Social no Brasil / Validity evidence of the Social Dominance Orientation Scale in Brazil / Evidencias de validez de Escala de Orientación a Dominancia Social en Brasil

O presente estudo buscou adaptar a Escala de Orientação à Dominância Social (SDO7) para o contexto brasileiro, propor uma versão reduzida do instrumento, avaliar sua estrutura fatorial e evidências de validade entre grupos. Para tanto, realizou-se coleta de dados on-line em que participaram 1.056 indivíduos de quatro diferentes amostras. Análises fatoriais confirmatórias indicaram os melhores índices de ajuste para a estrutura original de quatro fatores, sendo dois substanciais (Dominância e Anti-Igualitarismo) e dois de método (pró-traço e contra-traço). Os fatores substanciais, denominados "Dominância Social" e "Anti-Igualitarismo", apresentaram alfa de Cronbach superior a 0,70 em todas as amostras. As versões longa e reduzida da escala apresentaram bons índices de validade de critério entre grupos com correlações altas entre os escores dos fatores substanciais e a autocategorização política. Portanto, o instrumento apresentou evidências de validade e fidedignidade e podem ser utilizados em estudos futuros. (AU)

This study aims to cross-culturally adapt the Social Dominance Orientation Scale (SDO7) for the Brazilian context, propose a reduced version of the instrument, and assess its factor structure and validity evidences. Participants included 1,056 individuals across four different samples collected online. Confirmatory factor analyses indicated the best fit indices for the original four-factor structure, two substantial (Dominance x Anti-Egalitarianism) and two methodological (pro-trait x counter-trait). The substantial factors had Cronbach's alpha values above 0.70 in all samples. Furthermore, both the long and reduced versions of the scale were highly correlated with political self-categorization. Hence, the instrument in its long and reduced versions showed good validity and reliability evidences for the Brazilian context and can be used in future studies. (AU)

Este estudio tiene como objetivo adaptar transculturalmente la Escala de Orientación a la Dominancia Social (SDO7) para el contexto brasileño, proponer una versión reducida del instrumento, evaluar su estructura factorial y evidencias de validez entre grupos. Por lo que, se llevó a cabo una recogida de datos online en la que participaron 1056 individuos de cuatro muestras diferentes. Los análisis factoriales confirmatorios indicaron los mejores índices de ajuste para la estructura original de cuatro factores, dos de ellos son sustanciales (Dominancia x Anti-Igualitarismo) y los otros dos son metodológicos (pro-rasgo x contra-rasgo). Los factores sustanciales, denominados "Dominancia social" y "Anti-Igualitarismo", presentaron alfa de Cronbach por encima de 0,70 en todas las muestras. Las versiones larga y corta de la escala presentaron buenos índices de validez con altas correlaciones entre los puntajes de los factores sustanciales y la autocategorización política. Por lo tanto, el instrumento presentó evidencias de validez y confiabilidad para el contexto brasileño y puede utilizarse en futuros estudios. (AU)

Effect of a Brief Social Contact Video on Transphobia and Depression-Related Stigma Among Adolescents: A Randomized Clinical Trial.

Importance: Transphobia and stigma remain barriers to seeking mental health care for gender-diverse adolescents. Objective: To examine the utility of brief social contact-based video interventions of transgender protagonists with depression to reduce transphobia and depression-related stigma and increase treatment-seeking intentions among adolescents in the general population. Design, Setting, and Participants: During August 2021, a total of 1437 participants were recruited and randomly assigned to 1 of 4 video-based conditions in a 2:2:1:1 ratio: (1) transgender adolescent girls, (2) transgender adolescent boys, (3) cisgender adolescent girls, or (4) cisgender adolescent boys. Interventions: In each of the approximately 110-second videos, an empowered presenter shared their personal story about coping with depression and reaching out for help. Main Outcomes and Measures: The primary outcome was the score on the Attitudes Toward Transgender Men and Women (ATTMW) scale. Secondary outcomes were (1) a "gender thermometer" rating for warmth in transgender perception, (2) the Depression Stigma Scale (DSS) score, and (3) the General Health-Seeking Questionnaire (GHSQ) score. Results: Of the 1437 randomized participants, 1098 (76%) completed the postintervention assessment and passed all the validity tests (mean [SD] age, 16.9 [1.2] years; 481 [44%] male; 640 [58%] White). A significant change in attitudes toward transgender youth was found within the intervention group only (mean [SD] ATTMW scores: intervention group, 34.6 [23.1] at baseline to 32.8 [24.2] after intervention; P < .001; control group, 33.5 [23.4] at baseline to 32.4 [24.1] after intervention; P = .01). The mean (SD) total DSS scores decreased significantly across study groups (intervention: 1.3 [3.3]; control: 1.7 [3.3]; P < .001). A significant increase in intention to seek help from a parent was found in the intervention (mean [SD] GHSQ score, 0.2 [1.1]) and control (mean [SD] GHSQ score, 0.3 [1.2]) groups (P < .001), as was a decrease in those not wanting to seek help from anyone (mean [SD] GHSQ score: intervention, 0.2 [1.6], P = .009; control, 0.3 [1.2], P < .001) Secondary analyses revealed significant differences in baseline ATTMW scores and intervention effects between transgender and gender-diverse and cisgender participants and between lesbian, gay, bisexual, or queer (LGBQ) and straight participants (F = 36.7, P < .001) and heterosexual participants (F = 37.0, P < .001). A significant difference was also found in mean (SD) transgender warmth scores from baseline to after intervention between groups (2.6° [13.1°] in the intervention group vs 0.4° [8.3°] in the control group; P < .001). Conclusions and Relevance: In this randomized clinical trial, brief social contact-based videos proved efficacious in reducing transphobia and depression-related stigma and in increasing treatment-seeking intentions among adolescents in the general population. By personifying, individualizing, and providing face and voice to the experience of transgender youth, other adolescents, especially those who are cisgender and/or of a heterosexual orientation, can gain empathetic insights into the lives of their often marginalized and stigmatized fellow youth. Trial Registration: ClinicalTrials.gov Identifier: NCT04969003.

Barriers to COVID-19 Vaccine Uptake in the LGBTQIA Community.

Objectives. To report findings from qualitative research that describe sources of hesitancy and barriers to vaccine uptake among lesbian, gay, bisexual, transgender, queer, intersex, and asexual (LGBTQIA) populations. Methods. In March 2021, we conducted focus groups with members of the Los Angeles, California LGBTQIA community to identify barriers to becoming vaccinated. Semistructured interviews were conducted with 32 individuals in 5 focus groups. Thematic analysis was conducted to identify themes. Results. Historical and ongoing medical trauma, including misgendering, and perceived emotional violence emerged as significant barriers to LGBTQIA individuals becoming vaccinated. Fear of violence was found to be a major barrier among transgender individuals, whereas fear of an unwelcoming vaccination site was a barrier for seniors. Finally, surviving was a higher priority than becoming vaccinated. Conclusions. Participants reported vaccine hesitancy and barriers that are unique to the life experiences of LGBTQIA individuals; these include medical trauma, violence, stigma, and discrimination. Our findings highlight the need to include LGBTQIA leaders and trusted individuals in the development of vaccination education and the delivery of vaccination services. (Am J Public Health. 2022;112(3):405-407. https://doi.org/10.2105/AJPH.2021.306599).

'Us-Versus-Them': Othering in COVID-19 public health behavior compliance.

OBJECTIVE: We explored public perceptions about the COVID-19 pandemic to learn how those attitudes may affect compliance with health behaviors. METHODS: Participants were Central Pennsylvania adults from diverse backgrounds purposively sampled (based on race, gender, educational attainment, and healthcare worker status) who responded to a mixed methods survey, completed between March 25-31, 2020. Four open-ended questions were analyzed, including: "What worries you most about the COVID-19 pandemic?" We applied a pragmatic, inductive coding process to conduct a qualitative, descriptive content analysis of responses. RESULTS: Of the 5,948 respondents, 538 were sampled for this qualitative analysis. Participants were 58% female, 56% with ≥ bachelor's degree, and 50% from minority racial backgrounds. Qualitative descriptive analysis revealed four themes related to respondents' health and societal concerns: lack of faith in others; fears of illness or death; frustration at perceived slow societal response; and a desire for transparency in communicating local COVID-19 information. An "us-versus-them" subtext emerged; participants attributed non-compliance with COVID-19 behaviors to other groups, setting themselves apart from those Others. CONCLUSION: Our study uncovered Othering undertones in the context of the COVID-19 pandemic, occurring between groups of like-minded individuals with behavioral differences in 'compliance' versus 'non-compliance' with public health recommendations. Addressing the 'us-versus-them' mentality may be important for boosting compliance with recommended health behaviors.

Limites e possibilidades de agentes comunitários de saúde na identificação de sintomas depressivos / Límites y posibilidades de los agentes comunitarios de salud en la identificación de síntomas depresivos / Limitations and possibilities of community health workers in identifying depressive symptoms

RESUMO Objetivo: avaliar o conhecimento de agentes comunitários de saúde sobre identificação de sintomas depressivos na comunidade. Método: trata-se de pesquisa qualitativa, realizada em Unidade Básica de Saúde, em Teresina, Piauí, Brasil, com 15 agentes comunitários de saúde. Utilizou-se o método da Pesquisa-Ação. A produção dos dados aconteceu em janeiro e fevereiro de 2019, por meio de dois seminários temáticos, pautados no Método Criativo Sensível. Os discursos foram submetidos à análise temática. Resultados: agentes comunitários de saúde reconhecem os sintomas depressivos por tristeza, choro, isolamento, anedonia e solidão, manifestados pelos indivíduos. Os limites para essa identificação, relatados pelos profissionais, foram dificuldade de acesso aos usuários e às famílias e estigma e preconceito com a depressão. Quanto às possibilidades, destacaram-se acesso à informação sobre a temática pela mídia, diálogo/conversa estabelecido entre usuário e profissional e acesso à rede de apoio. Considerações finais: conclui-se que o reconhecimento, as limitações e as possibilidades de identificação de sintomas depressivos por esses profissionais refletem no diagnóstico, planejamento e implementação de ações no cuidado em saúde mental de forma precoce e segura.

RESUMEN Objetivo: evaluar el conocimiento de agentes comunitarios de salud sobre identificación de síntomas depresivos en la comunidad. Método: se trata de investigación cualitativa, realizada en Unidad Básica de Salud, en Teresina, Piauí, Brasil, con 15 agentes comunitarios de salud. Se utilizó el método de Investigación-acción. La producción de los datos tuvo lugar en enero y febrero de 2019, a través de dos seminarios temáticos, de acuerdo con el Método Creativo-sensible. Los discursos fueron sometidos al análisis temático. Resultados: Los agentes comunitarios de salud reconocen los síntomas depresivos por tristeza, llanto, aislamiento, anhedonia y soledad, manifestados por los individuos. Los límites para esa identificación, relatados por los profesionales, fueron dificultad de acceso a los usuarios y a las familias y estigma y prejuicio con la depresión. En cuanto a las posibilidades, se destacaron acceso a la información sobre la temática por los medios, diálogo/conversación establecido entre usuario y profesional y acceso a la red de apoyo. Consideraciones finales: se concluye que el reconocimiento, las limitaciones y las posibilidades de identificación de síntomas depresivos por parte de estos profesionales reflejan en el diagnóstico, la planificación e implementación de acciones en el cuidado en salud mental de forma precoz y segura.

ABSTRACT Objective: to evaluate the knowledge of community health workers about the identification of depressive symptoms in the community. Method: this is a qualitative research, conducted in a Primary Health Care Unit in Teresina, Piauí, Brazil, with 15 community health workers. We used the Action-Research method. Data production took place in January and February 2019, through two thematic seminars, guided by the Creative Sensitive Method.The speeches were submitted to thematic analysis. Results: community health workers recognize the depressive symptoms by means of sadness, crying, isolation, anhedonia and loneliness, manifested by individuals. The limitations to this identification, reported by professionals, were difficulty of access to users and families, as well as stigma and prejudice against depression. As for the possibilities, access to information about the theme through the media, dialogue/conversation established between users and professionals, besides access to a support network, were highlighted. Final considerations: we conclude that the recognition, limitations and possibilities of identification of depressive symptoms by these professionals are reflected in the diagnosis, planning and implementation of actions in mental health care in an early and safe way.