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1.
PLoS One ; 16(2): e0246998, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33606801

RESUMO

Discriminatory behaviors among inter-ethnic relations in schools have long been noted and studied, but there are several correlations between discriminatory behaviors and other constructs that need further investigation. As an example, the relation between perceived discrimination and contextual problems-which include family, school and peer problems-among children and adolescents in Latin America has received little attention from previous studies. Further, the mediating role of ethnic identification and collective self-esteem in this relation also needs to be considered as they could be proven as protective factors for discriminatory behavior and its outcomes. Therefore, this study aimed to, first, establish the relationship between perceived discrimination and contextual problems in inter-ethnic students aged 8-19 years living in Arica, Chile; and second, to identify the role that ethnic identification and collective self-esteem play within this relation. In order to investigate this matter, a cross-sectional study was carried out with 3700 students in 29 schools between the fourth year of primary education and the last year of secondary education, aged between 9-18 years, with 48.4% men and 51.6% women. The sample was divided into primary and secondary school groups. The scales utilized were the Everyday Discrimination Scale, Multi-Group Ethnic Identity Measure-Revised Scale, Collective Self-Esteem Scale and the dimensions of contextual family, school and peer problems, as well as the general index of contextual problems of the Child and Adolescent Assessment System. For data analysis, we tested a path analytic model at both the within and between levels to account for the relations between variables. In each group the models obtained an optimal fit. We found that perceived discrimination and ethnic identification were directly related to contextual problems (.23-.39), and collective self-esteem had only a mediating role. This study showed that strategized interventions focusing on ethnic identification and perceived discrimination should be utilized by schools to create a better developing environment.

2.
Psychiatr Serv ; : appips202000018, 2020 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-33334156

RESUMO

Since health care delivery in Chile was comprehensively reformed in 2005, treating schizophrenia for its populace has been guaranteed, regardless of individuals' type of health insurance coverage. The implementation of this national schizophrenia treatment program has facilitated timely access to care for Chileans with a first episode of schizophrenia, particularly for publicly insured individuals. Although this reform has benefited 98% of the population, significant challenges remain. These include the transition to new evidence-based interventions, such as coordinated specialty care with multielement interventions, and the development of an information system that permits monitoring and improvement of quality of care and treatment outcomes.

3.
Artigo em Inglês | MEDLINE | ID: mdl-33098651

RESUMO

The original version of this article unfortunately contained an error in article title.

4.
Child Adolesc Ment Health ; 25(4): 256-257, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33063384

RESUMO

Mental health in Chile has been significantly challenged by the beginning of a social crisis in October of 2019 and the COVID-19 pandemic of 2020. Despite widening of shortage of services, both the burgeoning of Telepsychiatry and a Presidential Initiative to integrate mental health to policy making and services provided by all sectors of government have mitigated the effects of this crisis.


Assuntos
Infecções por Coronavirus/psicologia , Saúde Mental , Pandemias , Pneumonia Viral/psicologia , Adolescente , Serviços de Saúde do Adolescente , Criança , Saúde da Criança , Serviços de Saúde da Criança , Pré-Escolar , Chile/epidemiologia , Planejamento em Saúde , Humanos , Lactente , Serviços de Saúde Mental
5.
Artigo em Inglês | MEDLINE | ID: mdl-33021701

RESUMO

Approximately 1.251.225 foreign-born migrants reside in Chile, including 183.315 children. This study compares mental health indicators in immigrant and non-immigrant children to understand the mental health effects of migration. A cross-sectional study of 634 students from Chilean schools was conducted. Fifty percent of the students were immigrants. The System for the Evaluation of Children and Adolescents was used to evaluate mental health. No significant differences were observed in mental health indicators between immigrant and non-immigrant children. At both elementary and secondary levels, immigrant students had higher rates of contextual problems (family problems and problems with peers) and lower scores in integration and social consequence. Immigrant students in elementary schools scored lower in self-esteem. The higher rates of contextual problems in immigrant children should be addressed through structural changes in migration policies, such as providing support for employment of parents, welfare assistance, and access to health systems.

6.
Psychol Med ; : 1-10, 2020 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-32772968

RESUMO

BACKGROUND: In 1990, Latin American countries committed to psychiatric reforms including psychiatric bed removals. Aim of the study was to quantify changes in psychiatric bed numbers and prison population rates after the initiation of psychiatric reforms in Latin America. METHODS: We searched primary sources to collect numbers of psychiatric beds and prison population rates across Latin America between the years 1991 and 2017. Changes of psychiatric bed numbers were compared against trends of incarceration rates and tested for associations using fixed-effects regression of panel data. Economic variables were used as covariates. Reliable data were obtained from 17 Latin American countries: Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Ecuador, Honduras, Guatemala, Mexico, Nicaragua, Panama, Paraguay, Peru, El Salvador, Uruguay and Venezuela. RESULTS: The number of psychiatric beds decreased in 15 out of 17 Latin American countries (median -35%) since 1991. Our findings indicate the total removal of 69 415 psychiatric beds. The prison population increased in all countries (median +181%). Panel data regression analyses showed a significant inverse relationship -2.70 (95% CI -4.28 to -1.11; p = 0.002) indicating that prison populations increased more when and where more psychiatric beds were removed. This relationship held up when introducing per capita income and income inequality as covariates -2.37 (95% CI -3.95 to -0.8; p = 0.006). CONCLUSIONS: Important numbers of psychiatric beds have been removed in Latin America. Removals of psychiatric beds were related to increasing incarceration rates. Minimum numbers of psychiatric beds need to be defined and addressed in national policies.

7.
Psychol Med ; : 1-10, 2020 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-32758314

RESUMO

BACKGROUND: Evidence suggests the incidence of non-affective psychotic disorders (NAPDs) varies across persons and places, but data from the Global South is scarce. We aimed to estimate the treated incidence of NAPD in Chile, and variance by person, place and time. METHODS: We used national register data from Chile including all people, 10-65 years, with the first episode of NAPD (International Classification of Diseases, Tenth Revision: F20-F29) between 1 January 2005 and 29 August 2018. Denominators were estimated from Chilean National Census data. Our main outcome was treated incidence of NAPD and age group, sex, calendar year and regional-level population density, multidimensional poverty and latitude were exposures of interest. RESULTS: We identified 32 358 NAPD cases [12 136 (39.5%) women; median age-at-first-contact: 24 years (interquartile range 18-39 years)] during 171.1 million person-years [crude incidence: 18.9 per 100 000 person-years; 95% confidence interval (CI) 18.7-19.1]. Multilevel Poisson regression identified a strong age-sex interaction in incidence, with rates peaking in men (57.6 per 100 000 person-years; 95% CI 56.0-59.2) and women (29.5 per 100 000 person-years; 95% CI 28.4-30.7) between 15 and 19 years old. Rates also decreased (non-linearly) over time for women, but not men. We observed a non-linear association with multidimensional poverty and latitude, with the highest rates in the poorest regions and those immediately south of Santiago; no association with regional population density was observed. CONCLUSION: Our findings inform the aetiology of NAPDs, replicating typical associations with age, sex and multidimensional poverty in a Global South context. The absence of association with population density suggests this risk may be context-dependent.

8.
Ter. psicol ; 38(2): 203-222, ago. 2020. tab, graf
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1139730

RESUMO

Resumen El propósito de este estudio fue evaluar la asociación entre los problemas de regulación emocional e indicadores de salud mental en adolescentes de la ciudad Arica al Norte de Chile, además de describir y comparar los niveles de problemas interiorizados y exteriorizados entre hombres y mujeres. Participaron 2331 estudiantes de 11 a 20 años provenientes de establecimientos educacionales. Para medir los problemas de regulación emocional y los indicadores de salud mental, se utilizó el Sistema de Evaluación de Niños y Adolescentes (SENA). Los resultados muestran que los problemas de regulación emocional poseen efectos grandes y significativos sobre los problemas interiorizados y exteriorizados. Asimismo, se observó que las mujeres presentan mayor sintomatología depresiva, ansiosa, de ansiedad social y problemas de regulación emocional que los hombres. Pareciera ser que los adolescentes que manifiestan problemas para regular sus emociones son más vulnerables a experimentar estados de ánimos disfóricos, preocupaciones recurrentes o comportamientos disruptivos.


Abstract The aim of this study was to assess the relationship between emotional regulation problems and mental health outcomes in adolescents from the city of Arica in northern Chile, in addition to describing and comparing the levels of internalized and externalized problems between men and women. A total of 2331 students from 11 to 20 years old from educational establishments participated in the study. To measure emotional regulation problems and mental health indicators, the System of Evaluation of Children and Adolescents (SENA) was used. The results show that emotional regulation problems have large and significant effects on both internalized and externalized problems. Likewise, it was observed that women show more depressive, anxious, social anxiety and emotional regulation problems than men. It seems that adolescents who manifest problems in regulating their emotions are more vulnerable to experience dysphoric moods, recurrent worries or disruptive behavior.

9.
Autism ; 24(8): 2228-2242, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32715766

RESUMO

LAY ABSTRACT: Approximately 6 million individuals with autism spectrum disorder live in Latin America. In order to strengthen autism spectrum disorder research collaborations and awareness in the region, the Latin American Autism Spectrum Network (Red Espectro Autista Latinoamerica) was constituted in 2015, comprising researchers and clinicians from the following six countries: Brazil Argentina, Chile, Uruguay, Venezuela, and the Dominican Republic. This first multisite study from the Red Espectro Autista Latinoamerica network aims to describe the challenges and priorities to identify barriers to care and to map stigma among families of individuals with autism spectrum disorder living in Latin America. A total of 2942 caregivers from these six countries completed an online survey showing that the main priorities were greater community awareness and improvements in the educational system for individuals with autism spectrum disorder. In addition to that, the main barriers to care were related to lack of structure, mainly waiting lists (50.2%), high treatment costs (35.2%), and lack of specialized services (26.1%). Stigma experienced by families was frequent: one third reported feeling discriminated against and helpless for having a child with autism spectrum disorder. Also, 48.8% of the caregivers declared financial problems, 47.4% of them had to cut down work hours, and 35.5% had to leave their jobs because of their child's autism spectrum disorder. This is a pioneer study providing a description of the needs and challenges faced by families affected by autism spectrum disorder in Latin America, helping to build data-driven strategies at the national and regional levels.

10.
BMC Psychiatry ; 20(1): 104, 2020 03 05.
Artigo em Inglês | MEDLINE | ID: mdl-32138703

RESUMO

BACKGROUND: Child and adolescent mental health has scarcely been studied in developing countries, though it is an important aspect of health. Mental health problems in youth often continue into adulthood if not diagnosed or treated in time. METHODS: The Sistema de Evaluación de Niños y Adolescentes (SENA) [Child and Adolescent Evaluation System] was used to evaluate mental health indicators in a sample of students in Northern Chile. Two age-appropriate versions of the assessment were applied to a total sample of 5043 students, which included an elementary education sample of 1953 schoolchildren from fourth grade through sixth grade (ages 8 to 13 years), and a Secondary School sample of 3090 schoolchildren from seventh grade (the last year of elementary school) through the last year of Secondary school (senior high school) (ages 12 to 19 years). For each group, the version of the assessment used was determined by the students' grade level. Both samples included municipal, government-subsidized, and private schools. RESULTS: In this student population, depression, anxiety, and behavioral disorders were the main mental health problems identified, and indicators revealed a progressive increase in cases over the years, coinciding with the global epidemiological scenario. Males showed a greater presence of externalizing behaviors related to mental health problems associated with aggression and defiant behavior. However, females showed the highest number of mental health issues overall, especially regarding problems related to internalization. There are significant differences between school types. CONCLUSIONS: Our sample population analysis indicates that early intervention is necessary for the diagnosis and treatment of youth, with the goal of reducing the probability that psychiatric disorders will be prolonged, evolving, and worsening in adulthood.

12.
Ter. psicol ; 37(2): 97-103, ago. 2019. tab, graf
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1059109

RESUMO

Resumen La migración en Chile ha trascendido enormemente, siendo la educación uno de los principales focos de atención en miras de la transformación. El objetivo de este estudio es describir la discriminación percibida por escolares migrantes de la ciudad de Arica al Norte de Chile, analizando además la relación entre esta última y el estrés por aculturación. Participaron 678 estudiantes de ambos sexos entre Cuarto Básico a Cuarto Medio, entre los 8 y 19 años. Se utilizó la Escala de Discriminación en la Vida Cotidiana (eds) y la Escala de fuentes de estrés por aculturación (feac). Se encontraron diferencias significativas en la discriminación percibida entre escolares migrantes y no migrantes con una puntuación más alta en los migrantes en todas las edades. Se observa también una relación significativa entre discriminación percibida y estrés por aculturación. Se discuten los resultados y sus implicaciones, para el mejoramiento políticas públicas en el ámbito escolar.


Abstract Migration in Chile has transcended enormously, with education being one of the main focuses of attention in the face of transformation. The aim of this study is to describe the perceived discrimination by migrant school students from the city of Arica in the North of Chile, also analyzing the relationship between the latter and acculturation stress. 678 schoolchildren of both sexes participated between the Fourth grade to senior year at High School, with ages between 8 and 19. The Everyday Discrimination Scale (eds) and the Acculturation Stress Source Scale (feac) were used. Significant differences were found in perceived discrimination between migrant and non-migrant schoolchildren with a higher score among migrants at all ages. There is also a significant relationship between perceived discrimination and acculturation stress. The results and their implications are discussed, for the improvement of public policies in the school environment.

13.
Rev Panam Salud Publica ; 43: e33, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31093257

RESUMO

This analysis reviews the situation of child and adolescent mental health in Chile, organizational determinants, and the initiatives and interventions implemented to enhance child development despite the country's inequities. Progressive development of national mental health plans is covered, from the country's first plan in 2000, to growing the number of mental health professionals and the training they receive, such as MhGAP, to the implementation of "Chile Crece Contigo," whose preliminary evaluations are starting to show some effectiveness. However, the World Health Organization reports that progress in complying with the United Nations Convention of Children's Rights is insufficient. A set off legislative initiatives on behalf of children and adolescents have been passed, while others are being discussed in Parliament. There is much to be done in the nation as a whole and within its health system to ensure improved child and adolescent mental health and wellbeing. More research into child and adolescent mental health should be undertaken. Adequate funding and policymaking are also crucial to giving priority to child and adolescent mental health in Chile.

14.
Artigo em Inglês | PAHO-IRIS | ID: phr-50672

RESUMO

[ABSTRACT]. This analysis reviews the situation of child and adolescent mental health in Chile, organizational determinants, and the initiatives and interventions implemented to enhance child development despite the country’s inequities. Progressive development of national mental health plans is covered, from the country’s first plan in 2000, to growing the number of mental health professionals and the training they receive, such as MhGAP, to the implementation of “Chile Crece Contigo,” whose preliminary evaluations are starting to show some effectiveness. However, the World Health Organization reports that progress in complying with the United Nations Convention of Children´s Rights is insufficient. A set off legislative initiatives on behalf of children and adolescents have been passed, while others are being discussed in Parliament. There is much to be done in the nation as a whole and within its health system to ensure improved child and adolescent mental health and wellbeing. More research into child and adolescent mental health should be undertaken. Adequate funding and policymaking are also crucial to giving priority to child and adolescent mental health in Chile.


[RESUMEN]. En este análisis se examina la situación de la salud mental de niños y adolescentes en Chile, los determinantes institucionales y las iniciativas e intervenciones ejecutadas para mejorar el desarrollo infantil a pesar de las inequidades del país. Se ha abarcado el desarrollo progresivo de los planes nacionales de salud mental, desde el primer plan nacional en el año 2000, pasando por el aumento del número de profesionales de salud mental y la capacitación que reciben, como el programa MhGAP, hasta la ejecución de “Chile Crece Contigo”, cuyas evaluaciones preliminares están comenzando a mostrar cierta eficacia. Sin embargo, la Organización Mundial de la Salud informa que el progreso en el cumplimiento de la Convención de las Naciones Unidas sobre los Derechos del Niño es insuficiente. Se ha aprobado un conjunto de iniciativas legislativas a favor de los niños y adolescentes, mientras que otras están tratándose en el parlamento. Es mucho lo que hay por hacer en el país en general y en su sistema de salud para garantizar el mejoramiento de la salud mental y el bienestar de niños y adolescentes. Es necesario aumentar la investigación sobre la salud mental de niños y adolescentes. La disponibilidad de fondos suficientes y la formulación de políticas son también cruciales para dar prioridad a la salud mental de niños y adolescentes en Chile.


[RESUMO]. Uma análise foi realizada para examinar a situação da saúde mental de crianças e adolescentes no Chile, determinantes organizacionais e iniciativas e intervenções implementadas para melhorar o desenvolvimento infantil diante das iniquidades no país. É descrita a evolução dos planos nacionais de saúde mental, a partir do primeiro plano elaborado em 2000, o crescimento do número de profissionais de saúde mental e a capacitação recebida, como parte do programa mundial de ação para reduzir as lacunas em saúde mental da OMS (MhGAP), e a implementação do programa Chile Crece Contigo cujas avaliações preliminares indicam certo grau de efetividade. Porém, segundo informou a Organização Mundial da Saúde (OMS), houve pouco progresso no cumprimento da Convenção das Nações Unidas sobre os Direitos da Criança. Um conjunto de iniciativas legislativas em prol das crianças e adolescentes foi aprovado e outras propostas estão em debate no congresso. Há ainda muito a ser feito no país como um todo e dentro do sistema de saúde para garantir melhor saúde mental e bem-estar para crianças e adolescentes. Devem ser realizadas outras pesquisas sobre saúde mental da criança e do adolescente. É indispensável dispor de financiamento e políticas adequados que priorizem a saúde mental da criança e do adolescente no Chile.


Assuntos
Serviços de Saúde Mental , Serviços de Saúde da Criança , Serviços de Saúde do Adolescente , Programas Nacionais de Saúde , Chile , Programas Nacionais de Saúde , Serviços de Saúde Mental , Serviços de Saúde da Criança , Serviços de Saúde do Adolescente , Serviços de Saúde Mental , Serviços de Saúde da Criança , Serviços de Saúde do Adolescente , Programas Nacionais de Saúde
15.
Rev Panam Salud Publica ; 42, sep. 2018. Special Issue Alma-Ata.
Artigo em Espanhol | PAHO-IRIS | ID: phr-49470

RESUMO

[RESUMEN]. El presente artículo identifica estrategias que han contribuido al desarrollo de la capacidad de respuesta de la atención primaria en salud mental en Chile y analiza algunos aprendizajes de este proceso. Se destacan la formulación de planes nacionales de salud mental, el desarrollo gradual de un sistema de información, la inversión de fondos adicionales, la creación de programas y orientaciones; el desarrollo de recursos humanos, el posicionamiento de la salud mental en las redes integradas de servicios de salud, el apoyo al desarrollo biopsicosocial de la infancia, el modelo de atención familiar y comunitario, el reforzamiento de liderazgos y alianzas entre salud y servicios sociales. Como indicadores de la capacidad de respuesta se muestran el aumento de recursos para salud mental en atención primaria, tanto financieros como en la cantidad y capacitación de profesionales, y el aumento de procesos de salud mental en atención primaria, destacándose la tasa de personas en tratamiento por trastornos mentales y las prestaciones de apoyo al desarrollo de la infancia. Se analizan diversos factores que han contribuido a los avances de la atención primaria en salud mental, así como algunas debilidades de este proceso. Como conclusión, se muestra a otros países de la Región la factibilidad de avanzar hacia los postulados de Alma-Ata, implementando gradualmente cambios sustanciales en la capacidad de respuesta de la atención primaria en salud mental. Para este efecto, se recomienda aumentar la calidad y cantidad de la investigación en el tema, con metodologías que permitan comparaciones entre distintos países de la Región.


[ABSTRACT]. This article identifies strategies that have contributed to the development of mental health response capacity in primary care in Chile and analyzes some lessons learned from this process. It highlights the formulation of national mental health plans, the gradual development of an information system, the investment of additional resources, the creation of programs and guidelines, human resources development, the positioning of mental health in integrated health service delivery networks, support for biopsychosocial child development, the family and community care model, and the strengthening of leadership and partnerships between health and human services. Its indicators of response capacity are the increase in resources for mental health in primary care, both financial and staffing (that is, the number of professionals and the training provided to them), and the expansion of mental health treatment in primary care settings, notably the rate of people in treatment for mental illness and the support provided for child development. The article analyzes different factors that have contributed to advances in primary care delivery of mental health services, together with some weaknesses in this process. It concludes by demonstrating the feasibility of progress toward the goals of Alma-Ata to other countries in the Region, gradually implementing substantial changes in mental health response capacity in primary care. To this end, it recommends an improvement in the quality and quantity of research in this area through methodologies that permit comparisons between countries in the Region.


[RESUMO]. O presente artigo identifica as estratégias que contribuíram para o desenvolvimento da capacidade de resposta da atenção primária em saúde mental no Chile e analisa alguns ensinamentos tirados neste processo. Nele se destacam a elaboração de planos nacionais de saúde mental, o desenvolvimento gradual do sistema de informação, o investimento de mais verbas, a criação de programas e diretrizes, o aperfeiçoamento dos recursos humanos, o posicionamento da saúde mental nas redes integradas de serviços de saúde, a ênfase ao desenvolvimento biopsicossocial infantil, o modelo de atenção familiar e comunitária e o fortalecimento de lideranças e parcerias entre saúde e serviços sociais. Entre os indicadores da capacidade de resposta apresentados estão o aumento de subsídios à saúde mental na atenção primária, com mais recursos financeiros e um maior número de profissionais capacitados, e o investimento nos processos de saúde mental na atenção primária, com o aumento da taxa de pessoas em tratamento por transtornos mentais e serviços de puericultura. No artigo são examinados os fatores contribuintes para o avanço da atenção primária em saúde mental, bem como as deficiências deste processo. Em conclusão, demonstrase aos outros países da Região a viabilidade do progresso rumo aos princípios de Alma-Ata, com a implementação gradual de reformas importantes na capacidade de resposta da atenção primária em saúde mental. Recomenda-se realizar mais estudos e pesquisas de qualidade nesta área com o uso de metodologias que possibilitem uma análise comparativa entre os países da Região.


Assuntos
Atenção Primária à Saúde , Saúde Mental , Saúde Pública , Política de Saúde , Atenção Primária à Saúde , Saúde Mental , Saúde Pública , Política de Saúde , Atenção Primária à Saúde , Saúde Mental , Saúde Pública , Política de Saúde
16.
J Med Internet Res ; 20(1): e38, 2018 01 31.
Artigo em Inglês | MEDLINE | ID: mdl-29386172

RESUMO

BACKGROUND: Despite evidence on efficacious interventions, a great proportion of depressed adolescents do not receive evidence-based treatment and have no access to specialized mental health care. Remote collaborative depression care (RCDC) may help to reduce the gap between needs and specialized mental health services. OBJECTIVE: The objective of this study was to assess the feasibility, acceptability, and effectiveness of an RCDC intervention for adolescents with major depressive disorder (MDD) living in the Araucanía Region, Chile. METHODS: A cluster randomized, assessor-blind trial was carried out at 16 primary care centers in the Araucanía Region, Chile. Before randomization, all participating primary care teams were trained in clinical guidelines for the treatment of adolescent depression. Adolescents (N=143; 13-19 years) with MDD were recruited. The intervention group (RCDC, N=65) received a 3-month RCDC treatment that included continuous remote supervision by psychiatrists located in Santiago, Chile's capital city, through shared electronic health records (SEHR) and phone patient monitoring. The control group (enhanced usual care or EUC; N=78) received EUC by clinicians who were encouraged to follow clinical guidelines. Recruitment and response rates and the use of the SEHR system were registered; patient adherence and satisfaction with the treatment and clinician satisfaction with RCDC were assessed at 12-week follow-up; and depressive symptoms and health-related quality of life (HRQoL) were evaluated at baseline and 12-weeks follow-up. RESULTS: More than 60.3% (143/237) of the original estimated sample size was recruited, and a response rate of 90.9% (130/143) was achieved at 12-week follow-up. A mean (SD) of 3.5 (4.0) messages per patient were written on the SEHR system by primary care teams. A third of the patients showed an optimal adherence to psychopharmacological treatment, and adolescents in the RCDC intervention group were more satisfied with psychological assistance than those in EUC group. Primary care clinicians were satisfied with the RCDC intervention, valuing its usefulness. There were no significant differences in depressive symptoms or HRQoL between groups. Satisfaction with psychological care, in both groups, was related to a significant change in depressive symptomatology at 12-weeks follow-up (beta=-4.3, 95% CI -7.2 to -1.3). CONCLUSIONS: This is the first trial of its kind in Latin America that includes adolescents from vulnerable backgrounds, with an intervention that proved to be feasible and well accepted by both patients and primary care clinicians. Design and implementation issues may explain similar effectiveness across arms. The effectiveness of the intervention seems to be comparable with an already nationwide established treatment program that proved to be highly efficacious under controlled conditions. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01860443; https://clinicaltrials.gov/ct2/show/NCT01860443 (Archived by WebCite at http://www.webcitation.org/6wafMKlTY).


Assuntos
Transtorno Depressivo Maior/terapia , Adolescente , Adulto , Chile , Feminino , Humanos , Masculino , Adulto Jovem
17.
J Adolesc ; 63: 129-141, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29304385

RESUMO

While adolescent-parent disagreements about family functioning are common, they may also be indicative of family members' health problems and may compromise adolescent adjustment. This study examines the association between maternal depressive symptoms and family functioning perceptions, considering both the adolescents' and their mothers' points of view. A sample of 943 Chilean dyads of adolescents (69% female, Mage = 14.43 years old) and their mothers (Mage = 43.20 years) reported their perceptions of family cohesion and adaptability. Mothers also reported their depressive symptoms. Results indicated that mothers perceived their family as more cohesive and more adaptable than their children. There was a negative association between maternal and adolescent reports of family cohesion and maternal depressive symptoms. In the mother' reports, this association depended on adolescent's age. In the case of adolescents' reports, this association depended on adolescent's gender. Finally, maternal depressive symptoms were a significant predictor of mother-adolescent agreement about family cohesion.


Assuntos
Desenvolvimento do Adolescente , Depressão/psicologia , Relações Mãe-Filho/psicologia , Mães/psicologia , Adolescente , Adulto , Fatores Etários , Criança , Chile , Estudos Transversais , Feminino , Humanos , Masculino , Fatores Sexuais
18.
Rev Panam Salud Publica ; 42: e136, 2018.
Artigo em Espanhol | MEDLINE | ID: mdl-31093164

RESUMO

This article identifies strategies that have contributed to the development of mental health response capacity in primary care in Chile and analyzes some lessons learned from this process. It highlights the formulation of national mental health plans, the gradual development of an information system, the investment of additional resources, the creation of programs and guidelines, human resources development, the positioning of mental health in integrated health service delivery networks, support for biopsychosocial child development, the family and community care model, and the strengthening of leadership and partnerships between health and human services.Its indicators of response capacity are the increase in resources for mental health in primary care, both financial and staffing (that is, the number of professionals and the training provided to them), and the expansion of mental health treatment in primary care settings, notably the rate of people in treatment for mental illness and the support provided for child development.The article analyzes different factors that have contributed to advances in primary care delivery of mental health services, together with some weaknesses in this process. It concludes by demonstrating the feasibility of progress toward the goals of Alma-Ata to other countries in the Region, gradually implementing substantial changes in mental health response capacity in primary care. To this end, it recommends an improvement in the quality and quantity of research in this area through methodologies that permit comparisons between countries in the Region.

19.
Rev. panam. salud pública ; 42: e136, 2018. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-961821

RESUMO

RESUMEN El presente artículo identifica estrategias que han contribuido al desarrollo de la capacidad de respuesta de la atención primaria en salud mental en Chile y analiza algunos aprendizajes de este proceso. Se destacan la formulación de planes nacionales de salud mental, el desarrollo gradual de un sistema de información, la inversión de fondos adicionales, la creación de programas y orientaciones; el desarrollo de recursos humanos, el posicionamiento de la salud mental en las redes integradas de servicios de salud, el apoyo al desarrollo biopsicosocial de la infancia, el modelo de atención familiar y comunitario, el reforzamiento de liderazgos y alianzas entre salud y servicios sociales. Como indicadores de la capacidad de respuesta se muestran el aumento de recursos para salud mental en atención primaria, tanto financieros como en la cantidad y capacitación de profesionales, y el aumento de procesos de salud mental en atención primaria, destacándose la tasa de personas en tratamiento por trastornos mentales y las prestaciones de apoyo al desarrollo de la infancia. Se analizan diversos factores que han contribuido a los avances de la atención primaria en salud mental, así como algunas debilidades de este proceso. Como conclusión, se muestra a otros países de la Región la factibilidad de avanzar hacia los postulados de Alma-Ata, implementando gradualmente cambios sustanciales en la capacidad de respuesta de la atención primaria en salud mental. Para este efecto, se recomienda aumentar la calidad y cantidad de la investigación en el tema, con metodologías que permitan comparaciones entre distintos países de la Región.


ABSTRACT This article identifies strategies that have contributed to the development of mental health response capacity in primary care in Chile and analyzes some lessons learned from this process. It highlights the formulation of national mental health plans, the gradual development of an information system, the investment of additional resources, the creation of programs and guidelines, human resources development, the positioning of mental health in integrated health service delivery networks, support for biopsychosocial child development, the family and community care model, and the strengthening of leadership and partnerships between health and human services. Its indicators of response capacity are the increase in resources for mental health in primary care, both financial and staffing (that is, the number of professionals and the training provided to them), and the expansion of mental health treatment in primary care settings, notably the rate of people in treatment for mental illness and the support provided for child development. The article analyzes different factors that have contributed to advances in primary care delivery of mental health services, together with some weaknesses in this process. It concludes by demonstrating the feasibility of progress toward the goals of Alma-Ata to other countries in the Region, gradually implementing substantial changes in mental health response capacity in primary care. To this end, it recommends an improvement in the quality and quantity of research in this area through methodologies that permit comparisons between countries in the Region.


RESUMO O presente artigo identifica as estratégias que contribuíram para o desenvolvimento da capacidade de resposta da atenção primária em saúde mental no Chile e analisa alguns ensinamentos tirados neste processo. Nele se destacam a elaboração de planos nacionais de saúde mental, o desenvolvimento gradual do sistema de informação, o investimento de mais verbas, a criação de programas e diretrizes, o aperfeiçoamento dos recursos humanos, o posicionamento da saúde mental nas redes integradas de serviços de saúde, a ênfase ao desenvolvimento biopsicossocial infantil, o modelo de atenção familiar e comunitária e o fortalecimento de lideranças e parcerias entre saúde e serviços sociais. Entre os indicadores da capacidade de resposta apresentados estão o aumento de subsídios à saúde mental na atenção primária, com mais recursos financeiros e um maior número de profissionais capacitados, e o investimento nos processos de saúde mental na atenção primária, com o aumento da taxa de pessoas em tratamento por transtornos mentais e serviços de puericultura. No artigo são examinados os fatores contribuintes para o avanço da atenção primária em saúde mental, bem como as deficiências deste processo. Em conclusão, demonstra-se aos outros países da Região a viabilidade do progresso rumo aos princípios de Alma-Ata, com a implementação gradual de reformas importantes na capacidade de resposta da atenção primária em saúde mental. Recomenda-se realizar mais estudos e pesquisas de qualidade nesta área com o uso de metodologias que possibilitem uma análise comparativa entre os países da Região.


Assuntos
Humanos , Atenção Primária à Saúde/organização & administração , Saúde Mental , Saúde Pública , Política de Saúde
20.
Curr Psychiatry Rep ; 19(1): 2, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28097634

RESUMO

In many societies, family members are now the primary caregivers of mental health patients, taking on responsibilities traditionally under the purview of hospitals and medical professionals. The impact of this shift on the family is high, having both an emotional and economic toll. The aim of this paper is to review the main changes that occur in family dynamics for patients with schizophrenia. The article addresses three central themes: (i) changes in the family at the onset of the disorder, (ii) consequences for family members because of their caregiver role, and (iii) family interventions aimed at improving the complex dynamics within the family. After analyzing and discussing these themes, it is observed that despite advances in the field, the viability of taking care of a patient with schizophrenia by the family remains a challenge. Improving care will require commitments from the family, the mental health service system, and local and national governments for greater investments to improve the quality of life of society in general and individuals with schizophrenia in particular.


Assuntos
Cuidadores/psicologia , Efeitos Psicossociais da Doença , Relações Familiares/psicologia , Qualidade de Vida/psicologia , Esquizofrenia/diagnóstico , Psicologia do Esquizofrênico , Emoções Manifestas , Terapia Familiar , Comportamento de Busca de Ajuda , Humanos , Comunicação Interdisciplinar , Colaboração Intersetorial , Serviços de Saúde Mental , Relações Profissional-Família , Prognóstico , Esquizofrenia/terapia , Estigma Social , Apoio Social
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