Beliefs and attitudes of French family practitioners toward depression: the impact of training in mental health.

OBJECTIVE: To study, in a sample of French Family Practitioners (FPs), beliefs and attitudes toward depression and how they vary according to training received in mental health. METHODS: The Depression Attitude Questionnaire (DAQ) was completed by 468 FPs from all regions of France, recruited by pharmaceutical company representatives to attend focus groups on the management of depression in general practice. RESULTS: A three-factor model was derived from the DAQ, accounting for 37.7% of the total variance. The correlations between individual items of each component varied from 0.4 to 0.65, with an overall internal consistency of 0.47 (Cronbach's alpha). FPs had an overall neutral position on component 1, professional ease, a positive view on the origins of depression and its amenability to change (component 2), and a belief in the necessity of medication and the benefit of antidepressant therapy (component 3). Training in mental health, specifically through continuing medical education and postgraduate psychiatric hospital training, was significantly and positively associated with both professional ease and a medication approach to treating depression. CONCLUSION: This study is the first description of the beliefs and attitudes of French FPs toward depression using a standardized measure, the DAQ, despite the instrument's limited psychometric properties. It shows the positive effect of training in mental health on attitudes toward depression.

Role of the general practitioner in the care of patients recently discharged from the hospital after a first psychotic episode: influence of length of stay.

OBJECTIVE: It is unclear to what extent general practitioners are involved in the postdischarge care of patients hospitalized for a first psychotic episode and whether this involvement is influenced by length of stay in the hospital. The objectives of this study were to describe the role of the general practitioner in providing postdischarge care to patients with first-episode psychosis in terms of frequency and type of consultation and the extent of collaboration with hospital-based specialist services and to determine whether decreasing length of stay was accompanied by a modification in this role. METHOD: Six months after hospital discharge, a postal questionnaire was sent to the general practitioners of patients recruited to the French STEP cohort (Schizophrenie et son Traitement: une Evaluation de la Prize en charge), a prospective study of the clinical and social determinants of care pathways and prognosis for patients hospitalized for a first psychotic episode (DSM-IV criteria) in 5 services of the La Colombière Psychiatric Hospital, Montpellier, France. Length of stay in the hospital was dichotomized according to the median value of 35 days. Data collection took place from February 2008 to March 2009. RESULTS: Of the 121 STEP patients, 65% (n=79) had a regular general practitioner. The general practitioners had been informed by the hospital of the admission of their patient in only 17.9% (7/39) of cases. Of the general practitioners, 78.3% (47/60) had seen the patient at least once since discharge, with a median number of visits standardized over 6 months of 0.86 (range, 0-8.6). General practitioners were better informed with regard to diagnosis, date of discharge, name of psychiatrist, treatment, and community follow-up at discharge for patients with a short length of stay in the hospital, who were also more likely than those with a long length of stay to be consulting for mental health problems. CONCLUSIONS: Our findings suggest a low level of implication of general practitioners in providing postdischarge care to first-episode psychotic patients, irrespective of their length of hospital stay. Yet, the general practitioner has a role to play in coordinating and providing care for somatic health problems as well as psychiatric symptoms, specifically in the case of early discharge.

Depression among older people in Europe: the EURODEP studies.

The data from nine centres in Europe which had used the Geriatric Mental Scale (GMS) AGECAT were analysed to compare prevalence of diagnoses in subjects aged 65 years and over living in the community. Levels of depressive illness were: Iceland 8.8%, Liverpool 10.0%; Zaragoza 10.7%; Dublin 11.9%; Amsterdam 12.0%; Berlin 16.5%; London 17.3%; Verona 18.3% and Munich 23.6%. Taking all levels of depression, five high (Amsterdam, Berlin, Munich, London and Verona) and four low (Dublin, Iceland, Liverpool, Zaragoza) scoring centres were identified. Meta-analysis of all 13,808 subjects yielded a mean level of depression of 12.3% (95% CI 11.8-12.9), 14.1% for women (95% CI 13.5-14.8) and 8.6% for men (95% CI 7.9-9.3). Symptom levels varied between centres: 40% of the total study population in Amsterdam reported depressive mood against only 26% in Zaragoza. To incorporate studies from other centres using other methods for depression identification, the EURO-D scale was developed from 12 items of the GMS and validated against other scales and expert diagnosis. A two factor solution emerged, an 'affective suffering factor' and a 'motivation factor'. The EURO-D scale was applied to 14 population based surveys. Depression score tended to increase with age unlike levels of prevalence of depression. Large between centre differences were evident in levels of depression unexplained by age, gender or marital status. These data show that depressive illness defined as suitable for intervention is common among older people in Europe. Opportunities for effective treatment are almost certainly being lost. Levels of depressive symptoms vary significantly between high and low scoring centres, prompting the next phase of this study, an examination of risk factors in Europe.

Predictors of depressive symptoms in older people--a survey of two general practice populations.

BACKGROUND: Studies have shown strong associations between disability, social support and depressive symptoms in older people; but socio-economic effects are less clear and little is known about the role of health locus of control. OBJECTIVE: To examine the roles of physical health, disability, social support, socio-economic factors and health locus of control as predictors of depressive symptoms in older people. METHOD: A postal survey of patients aged >/= 65 years from two London practices. Outcome measure was a score of > 5 on the 15-item Geriatric Depression Scale. Associations with other factors were examined using logistic regression and expressed as odds ratios. RESULTS: 70.4% (1602/2276) responded and provided Geriatric Depression Score 15 data, with 23.8% (381/1602) scoring > 5. After adjusting for age, sex and practice, high depression scores were associated with: (i) physical health and disability [e.g. severe versus no disability odds ratio 26.9 (15.7-46.2)]; (ii) social support [e.g. dissatisfaction with support odds ratio 4.2 (3.2-5.6)]; (iii) socio-economic [e.g. no occupational pension odds ratio 1.9 (1.5-2.4)]; (iv) health locus of control [e.g. internality 0.6 (0.6-0.7)]. After adjusting for disability, associations with general measures of physical health were reduced but still significant, while associations with social support, socio-economic factors, and health locus of control were unaffected. All four groups of factors were included in a final model for predicting depressive symptoms. CONCLUSIONS: Disability, physical health, social support, socio-economic factors, and health locus of control were all independent depression score predictors in this study. This has implications for measures to reduce depressive symptoms in older people.

Social disablement among residents of hostels for the homeless in Rio de Janeiro, Brazil.

BACKGROUND: Knowledge of the extent of social disablement among homeless people is very useful for policy-makers and mental health professionals who are involved in the delivery of community-based care. As there are few studies of this issue in Brazil or other developing countries, a cross-sectional study was carried out among homeless people from the Rio de Janeiro (RJ) metropolitan area. METHOD: Data were collected on a random sample of 330 residents in the five public hostels using the 21-items Social Behaviour Scale (SBS) and the Composite International Development Interview (CIDI). RESULTS: The mean age of the 330 people in the sample was 44.8, 75.8% of them were men, 78.9% were single, 79.2% unemployed. Ten percent of the 330 residents had more than five social behaviour problems, but 39.4% of them had no problem. Some 26.7% were scored as under-active, 23.0% with poor self-care, 13.3% with slowness, 12.7% with restlessness and 11.8% inappropriate social mixing. Those with schizophrenia were reported to have many more disabilities in almost all of the SBS areas. On the other hand, depression and hostility were more frequent in those with diagnoses of depression and substance abuse disorders. Women were more likely to be reported as having disablement than men, explained by their greater prevalence rate of schizophrenia. CONCLUSIONS: In this population, social disablement was largely explained by those with schizophrenia. Active treatment strategies are needed for this group. Other residents had few behaviour problems, their most pressing problems come from their poor social circumstances.

The development of a scale to measure concepts of schizophrenia: experience among Brazilian psychiatrists

Foi desenvolvida uma escala para medir aderência ao conceito Bleuleriano Schneideriano de esquizofrenia entre psiquiatras trabalhando em Säo Paulo, analisando relaçöes entre variáveis sociodemográficas e de formaçäo sobre o escore obtido. Questionário contendo escala visual analógica com dezessete enunciados sobre conceitos Schneideriano e Bleuleriano de esquizofrenia, foi distribuído para 150 psiquiatras. As sub-escalas Bleuleriana e Schneideriana foram avaliadas por métodos psicométricos de consistência interna, estrutura das subescalas e confiabilidade test-reteste. Completaram o questionário 117 psiquiatras. A sub-escala Schneideriana demonstrou melhor consistência interna e melhores coeficientes de correlaçäo intraclasse. Näo houve associaçäo negativa entre os escores das sub-escalas. Discordância com o conceito Bleuleriano predominou entre profissionais treinados na USP. A baixa confiabilidade da sub-escla Bleuleriana limita a confiabilidade do instrumento como um todo, embora contribua para a discussäo dos modelos em questäo. Argumenta-se que o modelo Bleuleriano, por exigir maior inferência, torna-se propenso a baixa confiabilidade

Mortality among patients with non-affective functional psychoses in a metropolitan area of South-Eastern Brazil

Estudos sobre mortalidade na esquizofrenia e outras psicoses näo afetivas em diversos países industrializados têm consistentemente encontrado índices maiores que aqueles observados na populaçäo geral. A principal causa dessa maior mortalidade é o suicídio, ocorrendo em média 20 vezes mais freqüentemente do que na populaçäo geral. Esse tópico adquire relevância para a saúde pública no Brasil, em funçäo do aumento previsto no número de casos de psicoses no País devido à mudança de estrutura etária da populaçäo, e da política de saúde mental atual, que tem desestimulado a internaçäo psiquiátrica, priorizando o tratamento das psicoses na comunidade. Para investigar essa questäo, realizou-se estudo prospectivo no município de Säo Paulo, SP (Brasil). A amostra consistiu de 120 internaçöes consecutivas em uma regiäo delimitada daquele município, na faixa etária de 18 a 44 anos, com diagnóstico clínico de psicose funcional näo afetiva. A amostra foi seguida por 2 anos a partir da internaçäo psiquiátrica. Ao término desse período, foi possível estabelecer a evoluçäo de 116 pacientes (96,7 por cento). Sete pacientes faleceram (6 por cento dos 116 que completaram o estudo), sendo que 5 (4,3 por cento) cometeram suicídio. Quatro dos casos de suicídio ocorreram durante os primeiros 12 meses após a alta hospitalar. As Razöes de Mortalidade padronizadas para idade e sexo (relativos às taxas de mortalidade para a populaçäo de Säo Paulo) foram 8,4 para mortalidade geral (intervalo de confiança de 95 por cento: 4,0-15,9) e 317,9 para mortes por suicídio (intervalo de confiança de 95 por cento: 125.2-668.3). Os resultados do presente estudo indicam que as psicoses funcionais näo afetivas estäo associadas a uma esperança de vida menor que a observada na populaçäo geral. Vários países vêm priorizando, já por muitos anos, a atençäo psiquiátrica na comunidade. Tanto pacientes e familiares preferem essa alternativa de tratamento ao antigo modelo hospitalocêntrico. No entanto, é necessário que os programas de saúde mental no Brasil forneçam cuidados de saúde adequados aos pacientes que sofrem desses transtornos, particularmente no período que se segue à alta hospitalar, a fim de que se evite ao máximo uma evoluçäo täo desfavorável para os pacientes e seus familiares

The social adjustment of patients with schizophrenia: implications to the mental health policy in Brazil

A esquizofrenia é um importante problema de saúde pública em países desenvolvidos, afetando em média 0,5/1000 pessoas adultas e causando altos custos econômicos para a sociedade. Em países menos desenvolvidos näo há muitas informaçöes disponíveis, mas projeçöes baseadas nas taxas de incidência e tendências demográficas sugerem que o número de casos nesses países deve aumentar em 87 por cento de 1975 ao ano 2000. No Brasil, o diagnóstico de esquizofrenia representa cerca de um terço de todas as internaçöes psiquiátricas, e até o presente existe uma falta de informaçöes sobre as condiçöes reais desses pacientes. Com esse objetivo, uma amostra (n=124) de pacientes esquizofrênicos residentes em uma regiäo geográfica de captaçäo definida na cidade de Säo Paulo, Brasil, e que haviam sido internados consecutivamente em hospitais psiquiátricos dessa regiäo, foi avaliada quanto à psicopatologia e níveis de ajustamento social. Características sociodemográficas, socioeconômicas e ocupacionais também foram registradas. Os resultados indicaram uma populaçäo de pacientes com altos níveis de comprometimento psiquiátrico e de ajustamento social. Sessenta e cinco por cento apresentavam sintomas nucleares de esquizofrenia. Quase metade da amostra apresentou ajustamento social pobre ou muito pobre no mês anterior à internaçäo psiquiátrica. As áreas de funcionamento social mais afetadas foram participaçäo nas atividades domésticas, trabalho e isolamento social. Quase 30 por cento da amostra näo tinha nenhuma ocupaçäo e näo recebia nenhum tipo de benefício social, e mais de dois terços tinham renda per capita mensal de US$ 100,00 ou menos. A política de saúde mental atual de promover cuidados extra-hospitalares como alternativa ao modelo hopitalocêntrico anterior implicará o investimento para a criaçäo de uma rede de novos serviços de saúde mental, baseados na comunidade, que possam dar tratamento e apoio efetivos aos pacientes e suas famílias. É reforçada a necessidade de novas investigaçöes sobre o quadro atual de problemas psiquiátricos no país