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1.
Med Clin North Am ; 107(1): 143-167, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36402496

RESUMO

Cognitive-behavioral therapy (CBT) is a form of psychological treatment that is based on the underlying assumption that mental disorders and psychological distress are maintained by cognitive factors, that is, that general beliefs about the world, the self, and the future contribute to the maintenance of emotional distress and behavioral problems. The overall goal of CBT is to replace dysfunctional constructs with more flexible and adaptive cognitions. The most relevant cognitive-behavioral techniques in clinical practice are: i. Cognitive Restructuring (also known as the ABCDE method) is indicated to support patients dealing with negative beliefs or thoughts. The different steps in the cognitive restructuring process are summarized by the letters in the ABCDE acronym that describe the different stages of this coaching model: Activating event or situation associated with the negative thoughts, Beliefs and belief structures held by the individual that explain how they perceive the world which can facilitate negative thoughts, Consequences or feelings related to the activating event, Disputation of beliefs to allow individuals to challenge their belief system, and Effective new approach or effort to deal with the problem by facilitating individuals to replace unhelpful beliefs with more helpful ones. ii. Problem-Solving (also known as SOLVE) to raise awareness for specific triggers, and evaluate and choose more effective options. Each letter of the SOLVE acronym identifies different steps of the problem-solving process: Select a problem, generate Options, rate the Likely outcome of each option, choose the Very best option, and Evaluate how well each option worked. For example, a suicide attempt is reconceptualized as a failure in problem-solving. This treatment approach attempts to provide patients with a better sense of control over future emerging problems. iii. Re-attribution is a technique that enables patients to replace negative self-statements (eg, "it is all my fault") with different statements where responsibility is attributed more appropriately. Furthermore, decatastrophizing may help subjects, especially adolescents decide whether they may be overestimating the catastrophic nature of the precipitating event, and by allowing them to scale the event severity they learn to evaluate situations along a continuum rather than seeing them in black and white. iv. Affect Regulation techniques are often used with suicidal adolescents to teach them how to recognize stimuli that provoke negative emotions and how to mitigate the resulting emotional arousal through self-talk and relaxation.


Assuntos
Terapia Cognitivo-Comportamental , Transtornos Mentais , Suicídio , Adolescente , Humanos , Ideação Suicida , Objetivos , Suicídio/prevenção & controle , Terapia Cognitivo-Comportamental/métodos , Transtornos Mentais/terapia
4.
Clin Chest Med ; 43(4): 791-810, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36344081

RESUMO

This article is intended for use among all cystic fibrosis care team members. It covers common mental health concerns and their unique presentations in persons with cystic fibrosis (pwCF) in areas such as depression, anxiety, trauma, behavioral disorders emerging in childhood, sleep, problematic eating patterns, and the impact of substance use. Furthermore, the authors address ways to manage these mental health symptoms through risk assessment, psychological interventions, and/or psychotropic medications. Quick reference tables are provided for evidence-based psychological interventions and medications often used for mental health conditions in pwCF.


Assuntos
Fibrose Cística , Transtornos Mentais , Humanos , Fibrose Cística/psicologia , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia
5.
Epidemiol Psychiatr Sci ; 31: e81, 2022 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-36377410

RESUMO

AIMS: There is increasing evidence that brief psychological interventions delivered by lay providers can reduce common mental disorders in the short-term. This study evaluates the longer-term impact of a brief, lay provider delivered group psychological intervention (Group Problem Management Plus; gPM+) on the mental health of refugees and their children's mental health. METHODS: This single-blind, parallel, controlled trial randomised 410 adult Syrians in Azraq Refugee Camp in Jordan who screened positive for distress and impaired functioning to either five sessions of gPM+ or enhanced usual care (EUC). Primary outcomes were scores on the Hopkins Symptom Checklist-25 (HSCL-25; depression and anxiety scales) assessed at baseline, 6 weeks, 3 months and 12 months Secondary outcomes included disability, posttraumatic stress, personally identified problems, prolonged grief, prodromal psychotic symptoms, parenting behaviour and children's mental health. RESULTS: Between 15 October 2019 and 2 March 2020, 204 participants were assigned to gPM + and 206 to EUC, and 307 (74.9%) were retained at 12 months. Intent-to-treat analyses indicated that although participants in gPM + had greater reductions in depression at 3 months, at 12 months there were no significant differences between treatment arms on depression (mean difference -0.9, 95% CI -3.2 to 1.3; p = 0.39) or anxiety (mean difference -1.7, 95% CI -4.8 to -1.3; p = 0.06). There were no significant differences between conditions for secondary outcomes except that participants in gPM + had greater increases in positive parenting. CONCLUSIONS: The short-term benefits of a brief, psychological programme delivered by lay providers may not be sustained over longer time periods, and there is a need for sustainable programmes that can prolong benefits gained through gPM + .


Assuntos
Transtornos Mentais , Refugiados , Humanos , Adulto , Criança , Refugiados/psicologia , Intervenção Psicossocial , Síria , Psicoterapia , Método Simples-Cego , Seguimentos , Jordânia , Transtornos Mentais/terapia
7.
Epidemiol Psychiatr Sci ; 31: e79, 2022 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-36348492

RESUMO

AIMS: Mental health-related stigma and discrimination are a complex and widespread issue with negative effects on numerous aspects of life of people with lived experience of mental health conditions. Research shows that social contact is the best evidence-based intervention to reduce stigma. Within the context of a rapid development of remote technology, and COVID-19-related restrictions for face-to-face contact, the aim of this paper is to categorise, compare and define indirect social contact (ISC) interventions to reduce stigma and discrimination in mental health in low- and middle-income countries (LMICs). METHODS: MEDLINE, Global Health, EMBASE, PsychINFO, Cochrane Central Register of Control Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched using a strategy including terms related to 'stigma and discrimination', 'intervention', 'indirect social contact', 'mental health' and 'low- and middle-income countries'. Relevant information on ISC interventions was extracted from the included articles, and a quality assessment was conducted. Emerging themes were coded using a thematic synthesis method, and a narrative synthesis was undertaken to present the results. RESULTS: Nine studies were included in the review overall. One study was ineffective; this was not considered for the categorisation of interventions, and it was considered separately for the comparison of interventions. Of the eight effective studies included in synthesis, interventions were categorised by content, combination of stigma-reducing strategies, medium of delivery, delivery agents, target condition and population, as well as by active or passive interaction and follow-up. Most of the interventions used education and ISC. Recovery and personal experience were important content components as all studies included either one or both. Cultural adaptation and local relevance were also important considerations. CONCLUSIONS: ISC interventions were effective in overall terms for both the general public and healthcare providers, including medical students. A new definition of ISC interventions in LMICs is proposed. More research and better reporting of intervention details are needed to explore the effectiveness of ISC strategies in LMICs, especially in regions where little relevant research has been conducted.


Assuntos
COVID-19 , Transtornos Mentais , Humanos , Países em Desenvolvimento , Estigma Social , Saúde Mental , Transtornos Mentais/terapia , Transtornos Mentais/psicologia
8.
Tijdschr Psychiatr ; 64(9): 568-573, 2022.
Artigo em Holandês | MEDLINE | ID: mdl-36349852

RESUMO

BACKGROUND: In addition to impediments to social and social functioning, people with severe mental illness also experience the negative consequences of prejudice and stigmatization. Stigmatization also occurs in mental health care, including addiction care. AIM: To describe the occurrence and manifestations of stigmatization by care providers, from the perspective of clients and care providers. METHOD: Digital surveys among clients of the panel Psychisch Gezien (n = 628) and among care providers (n = 471). RESULTS: More than half (54%) of the panel members had experienced stigmatization by mental health care providers in the past two years. They experienced this mainly through a distant attitude (22%) and the language used by care providers (20%). Two-fifths (40%) of the care providers indicated that stigmatization occured regularly or often in their own team. Both clients and counselors emphasized the importance of normalizing mental health problems, reluctant use of psychiatric labels and recovery-oriented work to reduce stigma. CONCLUSION: Stigmatization by mental health care providers is manifested in many ways, making it a complex and ambiguous problem. Although there is no ‘one size fits all’ solution, normalization of mental problems is an important starting point.


Assuntos
Transtornos Mentais , Estereotipagem , Humanos , Saúde Mental , Preconceito , Estigma Social , Transtornos Mentais/terapia , Transtornos Mentais/psicologia
9.
Psychiatr Pol ; 56(3): 571-590, 2022 Jun 30.
Artigo em Inglês, Polonês | MEDLINE | ID: mdl-36342986

RESUMO

OBJECTIVES: The main issue presented in this article is the analysis of the therapeutic alliance as a non-specific factor healing various mental disorders and the effect of therapeutic alliance quality on patients' quality of life. METHODS: The sample consisted of 140 subjects: 85 patients participating in individual psychotherapy and 55 psychotherapists. To assess working alliance quality, the author used the Working Alliance Inventory (WAI; Horvath & Greenberg). The other measures used in the study were the Temporal Satisfaction With Life Scale (TSWLS; Pavot, Diener, & Suh) and the Psychological Well-Being Scale (PWBS; Ryff). RESULTS: The results showed that the actual effect of working alliance quality on short-term satisfaction with life was not statistically significant. It was found, however, that the effect of therapeutic alliance quality on psychological well-being was statistically significant and that a higher level of working alliance reported by the psychotherapist and the patient led to a greater sense of psychological well-being. The obtained values of correlation coefficients served as the basis for the hypothesis postulating a positive correlation between working alliance as well as its dimensions and the dimensions of psychological well-being. CONCLUSIONS: The working alliance is not related to short-term effects in psychotherapy, which means that it does not increase the current feeling of satisfaction with life as well as the experience of positive affect and contentment with life. The working alliance augments the quality of life understood as lasting and healthy development. It turns out that the psychotherapeutic alliance is a determinant of psychological well-being understood more deeply than merely as fleeting pleasure and more holistically, as an intrinsic, long-term element of healthy human development. The correlation of these two factors is significant.


Assuntos
Transtornos Mentais , Qualidade de Vida , Humanos , Relações Profissional-Paciente , Psicoterapia/métodos , Transtornos Mentais/terapia , Transtornos Mentais/psicologia , Satisfação Pessoal
11.
Prax Kinderpsychol Kinderpsychiatr ; 71(7): 658-676, 2022 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-36382739

RESUMO

Adolescents and young adults with mental illness have an increased risk of long-term unfavourable development and show high clinical severity and multiple psychosocial needs at an early age. In this context, several specific transitional psychiatric treatment services have been developed during the last years. The experience gained so far in adolescent psychiatry shows that a close interdisciplinary cooperation of child and adolescent psychiatry and adult psychiatry is necessary to address interface problems with the aim of a successful transition, as well as to prevent the development of severe and chronicmental illnesses. At the same time, there are many structural and content-related challenges that need to be integrated and addressed. In this review, different treatment models are presented and the requirements for successful transition psychiatry are discussed in the context of the existing evidence.


Assuntos
Psiquiatria Infantil , Transtornos Mentais , Transtornos Psicóticos , Criança , Adulto Jovem , Adolescente , Humanos , Psiquiatria do Adolescente , Transtornos Mentais/diagnóstico , Transtornos Mentais/terapia , Transtornos Mentais/psicologia , Psicoterapia
12.
Cien Saude Colet ; 27(12): 4553-4558, 2022 Dec.
Artigo em Português, Inglês | MEDLINE | ID: mdl-36383868

RESUMO

This text discusses people with mental disorders in conflict with the law in Brazil and the Custody and Psychiatric Treatment Hospitals, institutions included in the prison system and considered a hybrid between health and justice. When we present the reality in the national context, we show that the Psychiatric Reform did not reach these institutions, and these individuals continue to be stigmatized, and their human rights are violated. We substantiate the need to advance the debate and raise some questions to establish new solutions to tackle the issue and ensure well-structured, scientific evidence-based health care.


Este texto apresenta uma discussão a respeito das pessoas com transtorno mental em conflito com a lei no Brasil e os Hospitais de Custódia e Tratamento Psiquiátrico, instituições inseridas no sistema prisional e consideradas híbridas entre a saúde e a justiça. Ao apresentarmos a realidade no contexto nacional, evidenciamos que a Reforma Psiquiátrica não alcançou essas instituições e esses indivíduos seguem estigmatizados, tendo os seus direitos humanos violados. Fundamentamos a necessidade de avançarmos o debate e trazemos alguns questionamentos na tentativa de fomentar a criação de novas saídas para o enfrentamento do problema, bem como a garantia de cuidado em saúde bem estruturado e baseado em evidências científicas.


Assuntos
Transtornos Mentais , Prisioneiros , Humanos , Prisões , Hospitais Psiquiátricos , Transtornos Mentais/terapia , Direitos Humanos , Psicoterapia
13.
Cien Saude Colet ; 27(12): 4569-4577, 2022 Dec.
Artigo em Português, Inglês | MEDLINE | ID: mdl-36383870

RESUMO

This paper presents an experience report on the supervision of deinstitutionalization of the prison system through the articulation of the Psychosocial Care Network (RAPS) conducted from 2014 to 2021 within the Superintendence of Mental Health/Municipal Health Secretariat of Rio de Janeiro. This work of deinstitutionalizing people deprived of liberty with mental health problems consists of actions at the exit and entrance doors of the prison system and actions for the care of unimputable and imputable people with mental disorders. In the light of the Brazilian Psychiatric Reform, formalized by Law No. 10,216/2001, we aim to present an approach to this process counting on the possibilities of building care policies for insane offenders that are not punitive or segregating. The practical results of this work include more significant participation of the network in the construction of care for insane offenders, elaborating policies that avoid the prison career or reduce the asylum time in the penal system, and understanding that security measures must always have an outpatient nature.


Este artigo apresenta o relato da experiência de supervisão de desinstitucionalização do sistema prisional a partir da articulação da Rede de Atenção Psicossocial (RAPS), realizada de 2014 a 2021 no âmbito da Superintendência de Saúde Mental/Secretaria Municipal de Saúde do Rio de Janeiro. Trata-se de um trabalho de desinstitucionalização de pessoas privadas de liberdade com agravos em saúde mental e dividiu-se em atuações nas portas de saída e de entrada do sistema prisional e em ações voltadas para o cuidado de pessoas com transtornos mentais consideradas inimputáveis e imputáveis. À luz da Reforma Psiquiátrica Brasileira, formalizada pela Lei nº 10.216/2001, pretende-se apresentar uma abordagem sobre esse processo apostando em possibilidades de construir políticas de cuidado para o louco infrator que não sejam punitivistas ou segregadoras. Os resultados práticos desse trabalho incluem uma maior participação da rede na construção do cuidado para o louco infrator, a elaboração de políticas que evitem a carreira prisional ou reduzam o tempo de manicomialização no sistema penal e a compreensão de que a medida de segurança deve sempre ter caráter ambulatorial.


Assuntos
Transtornos Mentais , Saúde Mental , Humanos , Brasil , Desinstitucionalização , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Liberdade
15.
BMC Psychiatry ; 22(1): 692, 2022 11 09.
Artigo em Inglês | MEDLINE | ID: mdl-36352384

RESUMO

BACKGROUND: Multiple studies indicate that the prevalence of mental disorders in high-income countries has remained stable or increased despite substantial increases in the provision of care, leading some authors to question the effectiveness of increasing access to current treatments as a means of improving population mental health. METHODS: We developed a system dynamics model of mental disorder incidence and treatment-dependent recovery to assess two potential explanations for the apparent failure of increasing treatment provision to reduce mental disorder prevalence: 1) an increase in the individual-level risk of disorder onset; and 2) declining effectiveness of care resulting from insufficient services capacity growth. Bayesian Markov Chain Monte Carlo (MCMC) methods were used to fit the model to data on the prevalence of high to very high psychological distress in Australia for the period 2008-2019. RESULTS: Estimates of yearly rates of increase in the per capita incidence of high to very high psychological distress and the proportion of patients recovering when treated indicate that the individual-level risk of developing high to very high levels of distress increased between 2008 and 2019 (posterior probability > 0.999) but provide no evidence for declining treatment effectiveness. Simulation analyses suggest that the prevalence of high to very high psychological distress would have decreased from 14.4% in 2008 to 13.6% in 2019 if per capita incidence had not increased over this period (prevalence difference 0.0079, 95% credible interval 0.0015-0.0176). CONCLUSIONS: Our analyses indicate that a modest but significant effect of increasing access to mental health care in Australia between 2008 and 2019 was obscured by a concurrent increase in the incidence of high to very high psychological distress.


Assuntos
Transtornos Mentais , Serviços de Saúde Mental , Transtornos Psicóticos , Humanos , Saúde Mental , Teorema de Bayes , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Prevalência
16.
BMC Psychiatry ; 22(1): 697, 2022 11 11.
Artigo em Inglês | MEDLINE | ID: mdl-36368966

RESUMO

BACKGROUND: As severe mental illness (SMI) is associated with a high disease burden and persistent nature, patients with SMI are often subjected to long-term mental healthcare and are in need of additional social support services. Community-based care and support services are organized via different providers and institutions, which are often lacking structural communication, resulting in a fragmented approach. To improve the efficiency of care provision and optimize patient wellbeing, an integrated multi-agency approach to community-based mental health and social services has been developed and implemented. AIM: To present a research protocol describing the evaluation of flexible assertive community teams integrated with social services in terms of effectiveness, cost-effectiveness, and implementation. METHODS/DESIGN: A quasi-experimental study will be conducted using prospective and retrospective observational data in patients with severe mental illness. Patients receiving care from three teams, consisting of flexible assertive community treatment and separately provided social support services (care as usual), will be compared to patients receiving care from two teams integrating these mental and social services into a single team. The study will consist of three parts: 1) an effectiveness evaluation, 2) a health-economic evaluation, and 3) a process implementation evaluation. To assess (cost-)effectiveness, both real-world aggregated and individual patient data will be collected using informed consent, and analysed using a longitudinal mixed model. The economic evaluation will consist of a cost-utility analysis and a cost-effectiveness analysis. For the process and implementation evaluation a mixed method design will be used to describe if the integrated teams have been implemented as planned, if its predefined goals are achieved, and what the experiences are of its team members. DISCUSSION: The integration of health and social services is expected to allow for a more holistic and recovery oriented treatment approach, whilst improving the allocation of scarce resources. This study aims to identify and describe these effects using a mixed-method approach, and support decision-making in the structural implementation of integrating mental and social services.


Assuntos
Serviços Comunitários de Saúde Mental , Transtornos Mentais , Humanos , Análise Custo-Benefício , Estudos Prospectivos , Estudos Retrospectivos , Serviços Comunitários de Saúde Mental/métodos , Transtornos Mentais/terapia , Transtornos Mentais/psicologia
17.
BMC Psychiatry ; 22(1): 695, 2022 11 11.
Artigo em Inglês | MEDLINE | ID: mdl-36368947

RESUMO

BACKGROUND: People with severe mental illness (SMI) often suffer from long-lasting symptoms that negatively influence their social functioning, their ability to live a meaningful life, and participation in society. Interventions aimed at increasing physical activity can improve social functioning, but people with SMI experience multiple barriers to becoming physically active. Besides, the implementation of physical activity interventions in day-to-day practice is difficult. In this study, we aim to evaluate the effectiveness and implementation of a physical activity intervention to improve social functioning, mental and physical health. METHODS: In this pragmatic stepped wedge cluster randomized controlled trial we aim to include 100 people with SMI and their mental health workers from a supported housing organization. The intervention focuses on increasing physical activity by implementing group sports activities, active guidance meetings, and a serious game to set physical activity goals. We aim to decrease barriers to physical activity through active involvement of the mental health workers, lifestyle courses, and a medication review. Participating locations will be divided into four clusters and randomization will decide the start of the intervention. The primary outcome is social functioning. Secondary outcomes are quality of life, symptom severity, physical activity, cardiometabolic risk factors, cardiorespiratory fitness, and movement disturbances with specific attention to postural adjustment and movement sequencing in gait. In addition, we will assess the implementation by conducting semi-structured interviews with location managers and mental health workers and analyze them by direct content analysis. DISCUSSION: This trial is innovative since it aims to improve social functioning in people with SMI through a physical activity intervention which aims to lower barriers to becoming physically active in a real-life setting. The strength of this trial is that we will also evaluate the implementation of the intervention. Limitations of this study are the risk of poor implementation of the intervention, and bias due to the inclusion of a medication review in the intervention that might impact outcomes. TRIAL REGISTRATION: This trial was registered prospectively in The Netherlands Trial Register (NTR) as NTR NL9163 on December 20, 2020. As the The Netherlands Trial Register is no longer available, the trial can now be found in the International Clinical Trial Registry Platform via: https://trialsearch.who.int/Trial2.aspx?TrialID=NL9163 .


Assuntos
Transtornos Mentais , Qualidade de Vida , Humanos , Interação Social , Transtornos Mentais/terapia , Transtornos Mentais/psicologia , Exercício Físico , Estilo de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto
18.
BMC Psychiatry ; 22(1): 698, 2022 11 14.
Artigo em Inglês | MEDLINE | ID: mdl-36376844

RESUMO

BACKGROUND: For psychiatric service users suffering from severe mental disorders, the social support provided by personal social networks is essential for living a meaningful life within the community. However, the importance of the support received depend on the relations between the providers of social support. Yet this hasn't been addressed in the literature so far for people with severe mental disorders. This article seeks to investigate how characteristics of service users with severe mental disorders, their social contacts, and the pattern of relationships between those contacts influence the distribution and provision of social support to people with severe mental disorders. METHODS: We collected personal network data relating to 380 psychiatric service users from a random sample of health care providers in Belgium. We computed various measures of the structure of those networks and of the position of support persons within those networks. We conducted a multilevel analysis of the importance of the support provided by each support persons. RESULTS: The results show that the more central a support person was in the network of a service user, the more important his or her support was considered to be by the service user. Also, the denser the network in which a support person was embedded, the less important was the support he or she offers, but only for hospitalised service users. CONCLUSION: These finding highlight the collective dimension of social support. We discuss the implications for the organisation of mental health care.


Assuntos
Transtornos Mentais , Masculino , Feminino , Humanos , Análise Multinível , Transtornos Mentais/terapia , Transtornos Mentais/psicologia , Apoio Social , Rede Social , Pessoal de Saúde/psicologia
19.
PLoS One ; 17(11): e0277695, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36378651

RESUMO

BACKGROUND: We aimed to improve mental health referral quality of young people by helping educators build capacity for early identification of youth at risk of mental illness and facilitate referrals between the education and health systems. METHODS: We applied the Go-To Educator mental health literacy training for early identification, triage and support in 208 schools in Calgary, Alberta between 2013 and 2016. Students presenting to mental health services during this time were compared on a number of clinical, system, and demographic variables, based on the training status of the school (untrained schools; before and after training schools), using retrospective cohort design. Based on clinical and system data, bivariate and multivariable logistic regression analysis were employed to compare the three school status domains. RESULTS: After training, referrals differed significantly from control and pre-training schools. Students presenting to services from these schools were younger, from single parent families; were referred more because of adjustment and learning/attention problems; had complex social/family issues; thought disturbances, and harmful behavior/thoughts towards others. While they waited longer to be admitted they stayed longer in services; had more provisional comorbid diagnoses and demonstrated positive treatment outcomes. CONCLUSIONS: The Go-To Educator training may be an effective intervention helping educators identify students at risk of mental disorders and in substantial need of mental health services, demonstrating improved linkages between education and health sectors.


Assuntos
Letramento em Saúde , Transtornos Mentais , Serviços de Saúde Mental , Criança , Adolescente , Humanos , Saúde Mental , Estudos Retrospectivos , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Transtornos Mentais/diagnóstico , Encaminhamento e Consulta , Alberta , Serviços de Saúde Escolar
20.
Artigo em Inglês | MEDLINE | ID: mdl-36360813

RESUMO

Relatives play an important role in the recovery journey of mental health service users. Interventions directed either at service users or their relatives may influence the other person as well. The project 'Activa't per la salut mental' (Get active for mental health) consisted of a series of four interventions addressed at people diagnosed with mental disorders and their relatives to help them in their recovery process, increasing their agency and quality of life. The main objective of the present study is to evaluate the interaction of the participation of service users on their relatives' outcomes and vice versa. The impact of the project was evaluated within a randomised controlled trial. The treatment group had access to all the circuit interventions, while the control group received treatment as usual and could only access one of the interventions. All participants were evaluated at baseline, six months, and twelve months after the end of the first intervention. Service users were evaluated with the Stages of Recovery Instrument, and relatives with the Family Burden Interview Schedule II and the Duke-UNC-11 questionnaires. The interaction of participation and impact between service users and their relatives was analysed by means of correlational analyses within the intervention group (n = 111, service users mean age = 40.6, 40% women; relatives mean age = 56.7, 72% women). Service users' baseline characteristics (being in a relationship, educational level, employment, and younger age) influenced in the level of participation of relatives and vice versa (lower educational level). The results also indicated correlations between participation and outcomes at various points as well as the evolution of service users' recovery and the care burden of relatives. Service users' participation levels interacted with the decrease of relatives' frequency of burden and the first steps of their own recovery journey (moratorium, awareness, and preparation) while relative's participation just interacted with the evolution of two stages of service users' recovery levels (preparation and growth). These results can be extremely helpful in fostering interactive benefits in future projects addressing the wellbeing of mental health service users and their relatives. Future studies could use specific designs to explore the directionality of the causality of these effects.


Assuntos
Transtornos Mentais , Serviços de Saúde Mental , Feminino , Humanos , Adulto , Pessoa de Meia-Idade , Masculino , Intervenção Psicossocial , Qualidade de Vida , Transtornos Mentais/terapia , Saúde Mental
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