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1.
Depress Anxiety ; 2021 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-33393724

RESUMO

BACKGROUND: Healthcare workers are a key occupational group at risk for suicidal thoughts and behaviors (STB). We investigated the prevalence and correlates of STB among hospital workers during the first wave of the Spain COVID-19 outbreak (March-July 2020). METHODS: Data come from the baseline assessment of a cohort of Spanish hospital workers (n = 5450), recruited from 10 hospitals just after the height of the coronavirus disease 2019 (COVID-19) outbreak (May 5-July 23, 2020). Web-based self-report surveys assessed 30-day STB, individual characteristics, and potentially modifiable contextual factors related to hospital workers' work and financial situation. RESULTS: Thirty-day STB prevalence was estimated at 8.4% (4.9% passive ideation only, 3.5% active ideation with or without a plan or attempt). A total of n = 6 professionals attempted suicide in the past 30 days. In adjusted models, 30-day STB remained significantly associated with pre-pandemic lifetime mood (odds ratio [OR] = 2.92) and anxiety disorder (OR = 1.90). Significant modifiable factors included a perceived lack of coordination, communication, personnel, or supervision at work (population-attributable risk proportion [PARP] = 50.5%), and financial stress (PARP = 44.1%). CONCLUSIONS AND RELEVANCE: Thirty-day STB among hospital workers during the first wave of the Spain COVID-19 outbreak was high. Hospital preparedness for virus outbreaks should be increased, and strong governmental policy response is needed to increase financial security among hospital workers.

2.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33309957

RESUMO

INTRODUCTION: Healthcare workers are vulnerable to adverse mental health impacts of the COVID-19 pandemic. We assessed prevalence of mental disorders and associated factors during the first wave of the pandemic among healthcare professionals in Spain. METHODS: All workers in 18 healthcare institutions (6 AACC) in Spain were invited to web-based surveys assessing individual characteristics, COVID-19 infection status and exposure, and mental health status (May 5 - September 7, 2020). We report: probable current mental disorders (Major Depressive Disorder-MDD- [PHQ-8≥10], Generalized Anxiety Disorder-GAD- [GAD-7≥10], Panic attacks, Posttraumatic Stress Disorder -PTSD- [PCL-5≥7]; and Substance Use Disorder -SUD-[CAGE-AID≥2]. Severe disability assessed by the Sheehan Disability Scale was used to identify probable "disabling" current mental disorders. RESULTS: 9,138 healthcare workers participated. Prevalence of screen-positive disorder: 28.1% MDD; 22.5% GAD, 24.0% Panic; 22.2% PTSD; and 6.2% SUD. Overall 45.7% presented any current and 14.5% any disabling current mental disorder. Workers with pre-pandemic lifetime mental disorders had almost twice the prevalence than those without. Adjusting for all other variables, odds of any disabling mental disorder were: prior lifetime disorders (TUS: OR=5.74; 95%CI 2.53-13.03; Mood: OR=3.23; 95%CI:2.27-4.60; Anxiety: OR=3.03; 95%CI:2.53-3.62); age category 18-29 years (OR=1.36; 95%CI:1.02-1.82), caring "all of the time" for COVID-19 patients (OR=5.19; 95%CI: 3.61-7.46), female gender (OR=1.58; 95%CI: 1.27-1.96) and having being in quarantine or isolated (OR= 1.60; 95CI:1.31-1.95). CONCLUSIONS: One in seven Spanish healthcare workers screened positive for a disabling mental disorder during the first wave of the COVID-19 pandemic. Workers reporting pre-pandemic lifetime mental disorders, those frequently exposed to COVID-19 patients, infected or quarantined/isolated, female workers, and auxiliary nurses should be considered groups in need of mental health monitoring and support.

3.
J Psychosom Res ; 135: 110167, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32554105

RESUMO

BACKGROUND: We designed a collaborative care program for the integrated management of chronic musculoskeletal pain and depression, which frequently coexist in primary care patients. The aim of this study was to evaluate the cost-effectiveness of this program compared with care as usual. METHODS: We performed a cost-effectiveness analysis alongside a randomized clinical trial. Results were monitored over a 12-month period. The primary outcome was the incremental cost-effectiveness ratio (ICER). We performed cost-effectiveness analyses from the perspectives of the healthcare system and society using an intention-to-treat approach with imputation of missing values. RESULTS: We evaluated 328 patients (167 in the intervention group and 161 in the control group) with chronic musculoskeletal pain and major depression at baseline. From the healthcare system perspective, the mean incremental cost was €234 (p = .17) and the mean incremental effectiveness was 0.009 QALYs (p = .66), resulting in an ICER of €23,989/QALY. Costs from the societal perspective were €235 (p = .16), yielding an ICER of €24,102/QALY. These estimates were associated with a high degree of uncertainty illustrated on the cost-effectiveness plane. CONCLUSIONS: Contrary to our expectations, the collaborative care program had no significant effects on health status, and although the additional costs of implementing the program compared with care as usual were not high, we were unable to demonstrate a favorable cost-effectiveness ratio, largely due to the high degree of uncertainty surrounding the estimates.

4.
Rev. Fund. Educ. Méd. (Ed. impr.) ; 23(3): 121-127, mayo-jun. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-193878

RESUMO

INTRODUCCIÓN: En el marco de una estrategia para implementar un nuevo programa clínico para la depresión en atención primaria, desarrollamos un curso online con clases videograbadas dirigido a los médicos y enfermeras que van a introducir el programa en su práctica clínica. SUJETOS Y MÉTODOS: La evaluación del curso se realizó mediante un cuestionario estandarizado a los alumnos y un análisis temático de los contenidos de un foro de discusión. RESULTADOS: En la encuesta, los alumnos mostraron satisfacción respecto a sus expectativas, valorando positivamente el formato y el diseño general, los contenidos y su utilidad práctica, sin diferencias significativas según el perfil profesional. En el análisis cualitativo del foro se detectaron potencialidades del programa y del curso, destacando la percepción de que se abordaba una necesidad asistencial relevante. También se señalaron insuficiencias del curso y del programa, y obstáculos externos que pueden dificultar o impedir la implementación: falta de tiempo, inestabilidad en los equipos o exceso de trabajo y requerimientos en el día a día. CONCLUSIONES: Hemos ensayado un eficaz formato online para la formación de profesionales. La evaluación del curso ha sido satisfactoria. El feedback de los alumnos permitirá modelar y perfeccionar futuras ediciones del curso y el propio programa


INTRODUCTION: Within the framework of a strategy to implement a new clinical program for depression in primary care, we developed an online course with videotaped lectures targeted at doctors and nurses who will introduce the program into their clinical practice. SUBJECTS AND METHODS: The evaluation of the course was carried out by a standardized questionnaire for students and a thematic analysis of the contents of a discussion forum. RESULTS: In the survey, the students showed satisfaction regarding their expectations, positively valuing the format and the general design, the contents and their practical utility, without significant differences according to professional profile. In the qualitative analysis of the forum potentialities of the program and the course were detected, highlighting the perception that a relevant care need was addressed. There were also shortcomings of the course and the program, and external obstacles that may hinder or impede implementation: lack of time, instability in the staff, or excessive work and requirements on a day-to-day basis. CONCLUSIONS: We have tested an effective online format for the training of professionals. The evaluation of the course has been satisfactory. The feedback of the students will allow us to model and improve future editions of the course and the program itself


Assuntos
Humanos , Educação a Distância/métodos , Atenção Primária à Saúde , Depressão/epidemiologia , Educação Médica/métodos , Inquéritos e Questionários , Medicina de Família e Comunidade/educação , Educação em Enfermagem
5.
Pain Med ; 21(10): 2200-2211, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32100028

RESUMO

OBJECTIVE: The aims of this study were twofold: 1) to better understand the associations between pain-related cognitions and pain severity, and psychological and physical function, and 2) to determine the extent to which these cognitions function as mediators in the association between pain severity and depression in a sample of primary care adult patients with chronic pain and depression. DESIGN: Cross-sectional design. METHODS: Three hundred twenty-eight patients with both depression and chronic pain from primary care centers responded to measures of pain severity, pain interference, depression severity, and pain-related cognitions (including measures of catastrophizing and other pain-related beliefs). We performed three hierarchical regression analyses and two multiple regression analyses. RESULTS: The helplessness domain of pain catastrophizing was positively associated with pain severity, depression severity, and pain interference and mediated the relationship between depression and pain severity and vice versa. Beliefs about disability showed a positive association with pain severity, pain interference, and depression severity, and also mediated the relationship between pain severity and depression. Believing in a medical cure was positively associated with pain interference and negatively associated with depression; emotion beliefs were positively associated with pain severity. CONCLUSIONS: These findings provide important new information about the associations between several pain-related cognitions and pain severity, depression, and pain interference and the potential mediating roles that these cognitions play in the associations between pain severity and depression in patients with both chronic pain and depression in the primary care setting.

7.
J Affect Disord ; 252: 221-229, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-30986737

RESUMO

BACKGROUND: Depression and chronic musculoskeletal pain commonly occur as comorbid conditions, which increases their negative effects on health outcomes. The objective of this study was to assess the effectiveness of the DROP (DepRessiOn and Pain) programme designed for the management of major depression and chronic musculoskeletal pain in primary care. METHODS: A cluster-randomised controlled trial was carried out between June 2015 and December 2017 with 328 patients with major depression and chronic musculoskeletal pain, randomly allocated to either intervention arm or usual care arm. The intervention included care management, optimised management of depression, and a psychoeducational programme. Outcomes were monitored using blinded interviews over a 12-month period. TRIAL REGISTRATION: NCT02605278 (ClinicalTrials.gov). RESULTS: After 12 months, 274 patients were evaluated (83.5% participation). The severity of depression (Hopkins Symptom Checklist score) was 0.23 points lower in the intervention arm [1.11 vs. 1.34; CI95% = -0.42 to -0.04]. Intervention arm's response rate to antidepressant treatment was 18.9% higher [39.6% vs. 20.7%; OR = 2.74; CI95% = 1.12-6.67] and its remission rate for depression was 9.0% higher [20.1% vs. 11.1%; OR = 2.13; CI95% = 0.94-4.85] compared to the usual care arm. There were no significant differences between the two arms in terms of pain severity (Brief Pain Inventory severity score) [6.23 vs. 6.66; difference = -0.39; CI95% = -1.13-0.35] or pain response rate [18.7% vs. 18.5%; OR = 1.02; CI95% = 0.46-2.26]. LIMITATIONS: This is a pragmatic study, and poor adherence to the programme by patients and physicians was a main limitation. CONCLUSION: The programme improves clinical outcomes for depression, although no clinical benefits were seen for pain.


Assuntos
Dor Crônica/terapia , Transtorno Depressivo Maior/terapia , Colaboração Intersetorial , Dor Musculoesquelética/terapia , Atenção Primária à Saúde/métodos , Adulto , Antidepressivos/uso terapêutico , Dor Crônica/psicologia , Análise por Conglomerados , Transtorno Depressivo Maior/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor Musculoesquelética/psicologia , Educação de Pacientes como Assunto/métodos , Avaliação de Programas e Projetos de Saúde , Resultado do Tratamento
9.
Prim Care Diabetes ; 12(2): 163-171, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-28988658

RESUMO

OBJECTIVES: To determine the role of anxiety and depression on the incidence of cardiovascular events (CVE) in a Catalonian population with metabolic syndrome (MetS) over a five-year follow-up according to the number/type of MetS criteria. METHODS: Prospective study to determine the incidence of CVE according to the presence of anxiety and depression disorders among individuals with different combinations of clinical traits of the MetS. SETTING: Primary Care, Catalonia (Spain). SUBJECTS: 35-75 years old fulfilling MetS criteria without CVE at the initiation of follow-up (2009). We studied 16 MetS phenotypes [NCEP-ATPIII criteria] based on the presence of depression/anxiety. The primary endpoint was the incidence of CVE at five years. RESULTS: We analyzed 401,743 people with MetS (17.2% of the population); 8.7% had depression, 16.0% anxiety and 3.8% both. 14.5% consumed antidepressants and 20.8% tranquilizers. At the 5-year follow-up, the incidence of CVE was 5.5%, being 6.4% in men and 4.4% in women. On comparing individuals with and without depression the incidence of CVE was 6.7% vs. 5.3%, respectively (p<0.01), being 5.5% in both groups in relation to anxiety. CONCLUSION: Depression and anxiety play a role in the poor prognosis of patients with MetS. In Catalonia, the two predominant MetS phenotypes do not include obesity as a criterion.


Assuntos
Ansiedade/epidemiologia , Doenças Cardiovasculares/epidemiologia , Depressão/epidemiologia , Síndrome Metabólica/epidemiologia , Adulto , Idoso , Ansiedade/diagnóstico , Ansiedade/mortalidade , Ansiedade/psicologia , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/psicologia , Causas de Morte , Depressão/diagnóstico , Depressão/mortalidade , Depressão/psicologia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Síndrome Metabólica/diagnóstico , Síndrome Metabólica/mortalidade , Pessoa de Meia-Idade , Fenótipo , Prevalência , Prognóstico , Estudos Prospectivos , Fatores de Risco , Espanha/epidemiologia , Fatores de Tempo
10.
BMC Health Serv Res ; 17(1): 821, 2017 Dec 13.
Artigo em Inglês | MEDLINE | ID: mdl-29237444

RESUMO

BACKGROUND: Primary care is the principal clinical setting for the management of depression. However, significant shortcomings have been detected in its diagnosis and clinical management, as well as in patient outcomes. We developed the INDI collaborative care model to improve the management of depression in primary care. This intervention has been favorably evaluated in terms of clinical efficacy and cost-effectiveness in a clinical trial. Our aim is to bring this intervention from the scientific context into clinical practice. METHODS: Objective: To test for the feasibility and impact of a strategy for implementing the INDI model for depression in primary care. DESIGN: A quasi-experiment conducted in primary care. Several areas will be established to implement the new program and other, comparable areas will serve as control group. The study constitutes the preliminary phase preceding generalization of the model in the Catalan public healthcare system. PARTICIPANTS: The target population of the intervention are patients with major depression. The implementation strategy will also involve healthcare professionals, primary care centers, as well as management departments and the healthcare organization itself in the geographical areas where the study will be conducted: Camp de Tarragona and Vallès Occidental (Catalonia). INTERVENTION: The INDI model is a program for improving the management of depression involving clinical, instructional, and organizational interventions including the participation of nurses as care managers, the efficacy and efficiency of which has been proven in a clinical trial. We will design an active implementation strategy for this model based on the PARIHS (Promoting Action on Research Implementation in Health Services) framework. MEASURES: Qualitative and quantitative measures will be used to evaluate variables related to the successful implementation of the model: acceptability, utility, penetration, sustainability, and clinical impact. DISCUSSION: This project tests the transferability of a healthcare intervention supported by scientific research to clinical practice. If implementation is successful in this experimental phase, we will use the information and experience obtained to propose and plan the generalization of the INDI model for depression in the Catalan healthcare system. We expect the program to benefit patients, the healthcare system, and society. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03285659 ; Registered 12th September, 2017.


Assuntos
Comportamento Cooperativo , Depressão/terapia , Atenção Primária à Saúde , Análise Custo-Benefício , Estudos de Viabilidade , Humanos , Assistência Centrada no Paciente , Atenção Primária à Saúde/economia , Avaliação de Programas e Projetos de Saúde , Comportamento Social , Resultado do Tratamento
11.
Aten. prim. (Barc., Ed. impr.) ; 49(6): 359-367, jun.-jul. 2017. graf, ilus
Artigo em Espanhol | IBECS | ID: ibc-163882

RESUMO

A pesar de su relevancia clínica y de su importancia como problema de salud pública existen importantes deficiencias en el abordaje de la depresión. Las guías clínicas basadas en la evidencia son útiles para mejorar los procesos y los resultados clínicos, y para facilitar su implementación se ha ensayado su transformación en sistemas informatizados de apoyo a las decisiones clínicas. En este artículo se describen los fundamentos y principales características de una nueva guía clínica informatizada para el manejo de la depresión mayor desarrollada en el sistema sanitario público de Cataluña. Esta herramienta ayuda al clínico a establecer diagnósticos de depresión fiables y precisos, a elegir el tratamiento idóneo a priori según las características de la enfermedad y del propio paciente, y enfatiza en la importancia de un seguimiento sistemático para evaluar la evolución clínica y adecuar las intervenciones terapéuticas a las necesidades del paciente en cada momento


Despite its clinical relevance and its importance as a public health problem, there are major gaps in the management of depression. Evidence-based clinical guidelines are useful to improve processes and clinical outcomes. In order to make their implementation easier these guidelines have been transformed into computerised clinical decision support systems. In this article, a description is presented on the basics and characteristics of a new computerised clinical guideline for the management of major depression, developed in the public health system in Catalonia. This tool helps the clinician to establish reliable and accurate diagnoses of depression, to choose the best treatment a priori according to the disease and the patient characteristics. It also emphasises the importance of systematic monitoring to assess the clinical course, and to adjust therapeutic interventions to the patient's needs at all times


Assuntos
Humanos , Depressão/tratamento farmacológico , Tomada de Decisão Clínica/métodos , Sistemas de Apoio a Decisões Clínicas , Depressão/epidemiologia , Atenção Primária à Saúde , Informática Médica/métodos , Antidepressivos/uso terapêutico , Conduta do Tratamento Medicamentoso , Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo/epidemiologia
12.
Aten Primaria ; 49(6): 359-367, 2017.
Artigo em Espanhol | MEDLINE | ID: mdl-28081896

RESUMO

Despite its clinical relevance and its importance as a public health problem, there are major gaps in the management of depression. Evidence-based clinical guidelines are useful to improve processes and clinical outcomes. In order to make their implementation easier these guidelines have been transformed into computerised clinical decision support systems. In this article, a description is presented on the basics and characteristics of a new computerised clinical guideline for the management of major depression, developed in the public health system in Catalonia. This tool helps the clinician to establish reliable and accurate diagnoses of depression, to choose the best treatment a priori according to the disease and the patient characteristics. It also emphasises the importance of systematic monitoring to assess the clinical course, and to adjust therapeutic interventions to the patient's needs at all times.


Assuntos
Sistemas de Apoio a Decisões Clínicas , Depressão/diagnóstico , Depressão/terapia , Atenção Primária à Saúde , Algoritmos , Humanos
13.
BMC Psychiatry ; 16: 69, 2016 03 16.
Artigo em Inglês | MEDLINE | ID: mdl-27236335

RESUMO

BACKGROUND: Chronic musculoskeletal pain and depression are very common in primary care patients. Furthermore, they often appear as comorbid conditions, resulting in additive effect on adverse health outcomes. On the basis of previous studies, we hypothesise that depression and chronic musculoskeletal pain may benefit from an integrated management programme at primary care level. We expect positive effects on both physical and psychological distress of patients. OBJECTIVE: To determine whether a new programme for an integrated approach to chronic musculoskeletal pain and depression leads to better outcomes than usual care. DESIGN: Cluster-randomised controlled trial involving two arms: a) control arm (usual care); and b) intervention arm, where patients participate in a programme for an integrated approach to the pain-depression dyad. SETTINGS: Primary care centres in the province of Tarragona, Catalonia, Spain, Participants: We will recruit 330 patients aged 18-80 with moderate or severe musculoskeletal pain (Brief Pain Inventory, average pain subscale ≥5) for at least 3 months, and with criteria for major depression (DSM-IV). INTERVENTION: A multicomponent programme according to the chronic care model. The main components are care management, optimised antidepressant treatment, and a psychoeducational group action. Blind measurements: The patients will be monitored through blind telephone interviews held at 0, 3, 6 and 12 months. OUTCOMES: Severity of pain and depressive symptoms, pain and depression treatment response rates, and depression remission rates. ANALYSIS: The outcomes will be analysed on an intent-to-treat basis and the analysis units will be the individual patients. This analysis will consider the effect of the study design on any potential lack of independence between observations made within the same cluster. ETHICS: The protocol was approved by the Research Ethics Committee of the Jordi Gol Primary Care Research Institute (IDIAP), Barcelona, (P14/142). DISCUSSION: This project strengthens and improves treatment approaches for a major comorbidity in primary care. The design of the intervention takes into account its applicability under typical primary care conditions, so that if the programme is found to be effective it will be feasible to apply it in a generalised manner. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02605278 ; Registered 28 September, 2015.


Assuntos
Depressão/terapia , Transtorno Depressivo Maior/terapia , Dor Musculoesquelética/terapia , Atenção Primária à Saúde/métodos , Psicoterapia/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antidepressivos/uso terapêutico , Protocolos Clínicos , Análise por Conglomerados , Depressão/psicologia , Transtorno Depressivo Maior/psicologia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor Musculoesquelética/psicologia , Espanha , Resultado do Tratamento , Adulto Jovem
16.
J Ment Health Policy Econ ; 18(1): 17-25, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25862205

RESUMO

BACKGROUND: Borderline Personality Disorder (BPD) has been associated with an intensive use of health resources and a high economic burden. AIMS OF THE STUDY: The aim of this study is to analyze the use of mental healthcare resources by BPD patients, to identify the information gaps on BPD at the regional health databases and to describe specific indicators and patterns of care utilization by persons with BPD in order to guide evidence-informed policy planning in Catalonia (Spain). METHODS: A multi-level cross-design synthesis approach was applied following a mixed quantitative-qualitative analysis to estimate the regional service utilisation of patients with BPD. This framing analysis included estimates based on all available data on the use of services combined with prior expert knowledge gathered through a nominal group of key stakeholders in this field. RESULTS: The estimated year prevalence of BPD was 0.7% but only 9.6% of all BPD patients in Catalonia had any contact with the health care system. Of those, less than half contacted mental health care. BPD represented 1.7% of the total care load in the community mental health centres. A significant information gap was identified in all the official databases and impeded their direct use for planning and resource allocation in BPD. Expert knowledge was required to estimate rates of care utilization at every level of care system (primary care, specialized outpatient care and hospital care). Nevertheless the high pattern of care utilization identified at the databases was accurate according to the experts. DISCUSSION: Detection of BPD was lower than expected in the local, regional and national databases and registries of Catalonia. Local data was judged highly inaccurate by experts in comparison to data available on other mental disorders in the same databases. IMPLICATIONS FOR HEALTH POLICY AND RESEARCH: Specific incentives should be implemented to improve the availability and accuracy of information on BPD at the regional databases. When present, BPD should be coded before other psychiatric disorders in clinical records and health databases. Mental health surveys and psychiatric epidemiological studies should specifically incorporate BPD in their inclusion criteria and further studies on the utilisation pattern of this disorder are needed, both locally and internationally.


Assuntos
Transtorno da Personalidade Borderline/terapia , Serviços de Saúde/estatística & dados numéricos , Adolescente , Adulto , Transtorno da Personalidade Borderline/epidemiologia , Serviços Comunitários de Saúde Mental/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Políticas , Padrões de Prática Médica , Prevalência , Espanha , Adulto Jovem
17.
Aten. prim. (Barc., Ed. impr.) ; 47(3): 167-174, mar. 2015. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-134260

RESUMO

OBJETIVO: Estimar la proporción de resultados positivos en el cribado del trastorno bipolar (TB) entre los pacientes de atención primaria que consultan por problemas de naturaleza psicológica, y analizar sus características. DISEÑO: Estudio descriptivo transversal multicéntrico. Emplazamiento: Diecinueve consultas de atención primaria en diferentes comunidades autónomas. PACIENTES: La muestra estuvo formada por 360 pacientes consecutivos de atención primaria con edades entre 18 y 70 años visitados por síntomas psicológicos. Mediciones: El cribado para TB se realizó mediante el Mood Disorders Questionnaire. Se obtuvieron datos sobre calidad de vida (EuroQol-5D), impacto funcional (Sheehan Disability Inventory) y, mediante revisión de historias clínicas, datos sobre comorbilidad psiquiátrica y consumo de psicofármacos. RESULTADOS: Se obtuvo una proporción de cribados positivos del 11,9% (IC 95%: 8,8-15,7%). Solo en 2 de estos pacientes estaba registrado el diagnóstico de TB, y aunque más de la mitad recibían tratamiento con antidepresivos, solo 2 recibían tratamiento con estabilizadores del estado de ánimo. El cribado positivo se asocia a peor calidad de vida, a disfunción laboral, social y familiar, y a mayor estrés percibido. CONCLUSIONES: El cribado del TB en pacientes de atención primaria con otros problemas psicológicos da lugar a una notable proporción de resultados positivos, lo que indica que puede haber una prevalencia relevante de pacientes con TB, la mayor parte de ellos no diagnosticados y no tratados adecuadamente. Es necesario profundizar en la investigación para determinar el eventual papel que puede o debe asumir la atención primaria en la detección, el diagnóstico o el manejo de este trastorno


OBJECTIVE: To estimate the proportion of positive results in the screening of bipolar disorder (BD) among primary care patients presenting with psychological symptoms, and to analyze their characteristics. DESIGN: Multicenter cross-sectional study. Settings: Nineteen Primary Care clinics in different Spanish regions. PATIENTS: A total of 360 consecutive primary care patients aged 18 to 70, presenting with psychological symptoms. Measurements: Screening for BP was performed by means of the Mood Disorders Questionnaire. Data on quality of life (EuroQol-5D) and functional impairment (Sheehan Disability Inventory) were obtained. Data on psychiatric comorbidity and data on the use of psychotropic medication were acquired by review of medical records. RESULTS: Of the patients screened, 11.9% were positive (95% CI: 8.8%-15.7%). Only two patients had a diagnosis of BP in their clinical records and, although more than half received treatment with antidepressants, only two received treatment with mood stabilizers. Positive screening is associated with work, social and family dysfunction, greater perceived stress and poor quality of life. CONCLUSIONS: BD screening in primary care patients with psychological problems leads to a striking proportion of positive results, indicating that there may be a significant prevalence of BP patients, most of them undiagnosed and untreated. Further research is needed to determine the role that Primary Care can or should assume in the screening, diagnosis and management of this disorder


Assuntos
Humanos , Masculino , Feminino , Programas de Rastreamento/análise , Tratamento Preliminar/ética , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/psicologia , Atenção Primária à Saúde/métodos , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Estudos Transversais/métodos , Estudos Multicêntricos como Assunto/métodos , Programas de Rastreamento , Tratamento Preliminar/métodos , Transtorno Bipolar/complicações , Transtorno Bipolar/prevenção & controle , Atenção Primária à Saúde/organização & administração , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Estudos Transversais , Estudos Multicêntricos como Assunto
18.
Aten Primaria ; 47(3): 167-74, 2015 Mar.
Artigo em Espanhol | MEDLINE | ID: mdl-25007706

RESUMO

OBJECTIVE: To estimate the proportion of positive results in the screening of bipolar disorder (BD) among primary care patients presenting with psychological symptoms, and to analyze their characteristics. DESIGN: Multicenter cross-sectional study. SETTINGS: Nineteen Primary Care clinics in different Spanish regions. PATIENTS: A total of 360 consecutive primary care patients aged 18 to 70, presenting with psychological symptoms. MEASUREMENTS: Screening for BP was performed by means of the Mood Disorders Questionnaire. Data on quality of life (EuroQol-5D) and functional impairment (Sheehan Disability Inventory) were obtained. Data on psychiatric comorbidity and data on the use of psychotropic medication were acquired by review of medical records. RESULTS: Of the patients screened, 11.9% were positive (95%CI: 8.8%-15.7%). Only two patients had a diagnosis of BP in their clinical records and, although more than half received treatment with antidepressants, only two received treatment with mood stabilizers. Positive screening is associated with work, social and family dysfunction, greater perceived stress and poor quality of life. CONCLUSIONS: BD screening in primary care patients with psychological problems leads to a striking proportion of positive results, indicating that there may be a significant prevalence of BP patients, most of them undiagnosed and untreated. Further research is needed to determine the role that Primary Care can or should assume in the screening, diagnosis and management of this disorder.


Assuntos
Transtorno Bipolar/diagnóstico , Atenção Primária à Saúde , Adolescente , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Adulto Jovem
19.
J Affect Disord ; 166: 36-40, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25012408

RESUMO

BACKGROUND: A collaborative care programme for depression in primary care has proven clinical effectiveness over a 12-months period. Because depression tends to relapse and to chronic course, our aim was to determine whether the effectiveness observed in the first year persists during 3 years of monitoring. METHODS: Randomised controlled trial with twenty primary care centres were allocated to intervention group or usual care group. The intervention consisted of a collaborative care programme with clinical, educational and organisational procedures. Outcomes were monitored by a blinded interviewer at baseline, 12 and 36 months. Clinical outcomes were response to treatment and remission rates, depression severity and health-related quality of life. TRIAL REGISTRATION: ISRCTN16384353. RESULTS: A total of 338 adult patients with major depression (DSM-IV) were assessed at baseline. At 36 months, 137 patients in the intervention group and 97 in the control group were assessed (attrition 31%). The severity of depression (mean Patient Health Questionnaire-9 score) was 0.95 points lower in the intervention group [6.31 versus 7.25; p=0.324]. The treatment response rate was 5.6% higher in the intervention group than in the control group [66.4% versus 60.8%; p=0.379] and the remission rate was 9.2% higher [57.7% versus 48.5%; p=0.164]. No difference reached statistical significance. LIMITATIONS: The number of patients lost (31%) before follow-up may have introduced a bias. CONCLUSIONS: Clinical benefits shown in the first year were not maintained beyond: at 36 months the differences between the control group and the intervention group reduced in all the analysed variables.


Assuntos
Comportamento Cooperativo , Transtorno Depressivo Maior/terapia , Atenção Primária à Saúde/métodos , Adolescente , Adulto , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Espanha
20.
J Health Commun ; 19(11): 1248-58, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24708534

RESUMO

Because the media influences society's perceptions of reality, the treatment of mental illness in the news can have an effect on the societal stigma related to it. This study aimed to analyze the content and form of news items related to mental illness in Spanish newspapers in order to understand their role in propagating or attenuating stereotypes, prejudices, and stigma. The authors conducted a cross-sectional descriptive study on the basis of a review of news items related to mental illness appearing in the Spanish print media. A sample was taken from articles published on the subject in the 20 Spanish newspapers with the widest circulations over the course of the year 2010. Formal elements and content were analyzed by means of a structured evaluation system. The authors analyzed 695 news items. The content of 47.9% (n = 333) of the articles was not strictly related to mental illness, but rather clinical or psychiatric terms were used metaphorically, and frequently in a pejorative sense. The remaining 52.1% (n = 362) consisted of news items related specifically to mental illness. Of these, news items linking mental illness to danger were the most common (178 texts, 49.2%), specifically those associating mental illness with violent crime (130 texts, 35.9%) or a danger to others (126 texts, 34.8%). The results confirm the hypothesis that the press treats mental illness in a manner that encourages stigmatization. The authors appeal to the press's responsibility to society and advocate an active role in reducing the stigma towards mental illness.


Assuntos
Jornalismo Médico , Transtornos Mentais/psicologia , Jornais como Assunto/estatística & dados numéricos , Estigma Social , Estereotipagem , Estudos Transversais , Humanos , Espanha
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