ABSTRACT
Background: Depression is a highly prevalent disease in Chilean adults. Aim: To identify sociodemographic, biomedical, and psychosocial factors related with depression in a representative sample of the Chilean adult population. Material and Methods: Analysis of data from the National Health Survey 2016-2017 which included 5,291 participants aged > 15 years. Depression was assessed using the Composite International Diagnostic Interview (CIDI-SF). Association between sociodemographic data, health and psychosocial variables and depression was analyzed using Poisson regression with robust error. Results: The probability of depression was higher in women than in men (prevalence ratio (PR) = 2.13 [95% confidence intervals (CI): 1.65, 2.75]). In both genders, the probability was higher in people with frailty (women: PR = 10.0 [95% CI: 1.86, 18.1] and men: PR = 3.38 [95% CI: 2.72; 4.20]), severe chronic pain (women: PR = 2.84 [95% CI: 1.93, 4.18 and men: PR = 6.41 [95% CI: 3.59, 9.40]), presence of two or more diseases (women: PR = 4.15 [95% CI: 2.78, 6.20 and men: PR = 2.60 [95% CI: 1.39, 3.81]), perception of permanent stress (women: PR = 11.0 [95% CI: 6.13, 16.0], men: PR = 21.0 [95% CI: 10.2, 31.7]), financial stress (women: PR = 2.57 [95% CI: 1.87, 3.27] men: PR = 4.27 [95% CI: 2.48, 6.06] and poor or very poor perception of health (women: PR = 5.02 [95% CI: 1.92, 8.12], men: 2.09 [95% CI: 0.49, 3.69]). In men, the probability of depression was higher for widowers than married man (PR = 5.58 [95% CI: 2.5, 8.25]), presence of goiter (PR = 4.03 [95% CI: 1.99, 6.07]) and low social support (PR = 1.95 [95% CI: 1.18; 2.72]). Conclusions: The factors associated with a higher probability of depression are diverse in nature. Among these being women, frailty, chronic pain, multimorbidity and high perception of stress are important factors.
ABSTRACT
Resumen Introducción La cirugía bariátrica es una de las opciones efectivas para la reducción del peso corporal, sin embargo, no existe claridad respecto de la evolución de la baja de peso corporal, más aún, algunos hallazgos sugieren amplia variabilidad individual en la curva de variación del Índice de Masa Corporal (IMC). Los factores asociados a este fenómeno no son claros aún. Objetivo Esta investigación buscó identificar la influencia de factores psicológicos: autoeficacia alimentaria, patrones de alimentación y apoyo social percibido, en la variación del IMC en pacientes sometidos a cirugía bariátrica. Materiales y Método Participaron 31 pacientes intervenidos en un hospital público del sur de Chile. Se utilizó la curva de crecimiento de Gompertz para modelar las curvas de variación de IMC y regresión no lineal para conocer la influencia de las variables de estudio. Resultados El porcentaje máximo de reducción de IMC, se produjo al noveno mes tras la cirugía. El IMC de inicio mostró una influencia significativa en la reducción del IMC (p = 0,04) lo mismo que el apoyo social percibido, subfactor amigos (p = 0,03). Las variables psicológicas estudiadas, tratadas individualmente, no afectaron la curva de variación de IMC, sin embargo, tratadas de modo agrupado lograron predecir el porcentaje máximo de reducción de IMC y su velocidad, incluso controlando el IMC de inicio. Discusión: Se confirman hallazgos previos respecto de que la variabilidad individual en la evolución del IMC postcirugía se ve afectada por factores psicológicos. Conclusión Variables psicológicas y no exclusivamente biomédicas, inciden en la evolución del IMC postcirugía, por lo que se sugiere atender a estos aspectos, tanto en la evaluación prequirúrgica como en el seguimiento postcirugía.
Background Bariatric surgery is one of the effective options for the reduction of body weight, however, there is no clarity regarding the postoperative weight loss curve, moreover, there are findings that suggest wide individual variability and the factors associated with this phenomenon are not clear yet. Aim This study sought to identify the influence of psychological factors such as eating self-efficacy, eating patterns and social support on the variation of BMI in patients who have undergone bariatric surgery through the surgical technique of vertical sleeve gastrectomy. Materials and Method A total of 31 operated patients in a public hospital in southern Chile participated in the study. The Gompertz growth curve was used to model BMI variation curves and nonlinear regression to ascertain the influence of the study variables. Results The maximum weight loss occurs around the ninth month after surgery. The initial BMI shows a significant difference in the reduction of BMI (p = 0.04) as well as the social support perceived and the sub-factor friends (p = 0.03). The psychological variables, treated individually, had no effect on the weight variation curve; however, when treated as a group, they were able to predict the maximum of weight loss and its speed, even controlling for the initial BMI. Discussion According to previous studies, these findings confirm that the individual variability in the evolution of BMI after surgery is affected by psychosocial factors. Conclusion Pre-surgical assessment and post-surgery follow-up are recommended, taking into account not only biomedical variables but also psychological factors.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Social Support , Body Mass Index , Self Efficacy , Diet/psychology , Bariatric Surgery/psychology , Chile , Surveys and Questionnaires , Sex Distribution , Age DistributionABSTRACT
During the sixties, the psychiatric care models evolved to a community care model, as a consequence of the asylum model failure. This new model assumes that psychosocial issues have a role, along with biological factors, in the development of mental diseases. In 2017 the National Mental health plan was created, based on this new model. It aimed to correct the flaws of the previous plan. We herein review this new plan, based on previous and international experiences. We also analyze the implementation of a community model of mental health care. The implementation of such a model without the support of the state and overlooking importance of mental health care, is extremely difficult.