Equivalência conceitual e semântica da versão em português da escala Community Attitudes toward Mentally III (CAMI) / Conceptual and semantic equivalence of the Portuguese version of thescale Community Attitudes toward Mentally Ill (CAMI)

A atitude negativa da comunidade em relação aos doentes mentais é um dos principais entraves para a implantação e expansão de serviços de saúde mental em áreas residenciais. Estudos internacionais demonstram que o medo, a falta de conhecimento sobre os serviços e o estereótipo continuam a ser obstáculos para a efetividade do tratamento e para a reintegração social do paciente. No Brasil há uma carência de estudos utilizando escalas para aferir as atitudes da comunidade em relação aos doentes mentais. Realizar a adaptação transcultural da escala Community Attitudes toward Mentally Ill (CAMI) utilizada para medir as atitudes da comunidade em relação aos doentes mentais. A adaptação transcultural da escala para o contexto cultural brasileiro foi realizada segundo os procedimentos recomendados pela literatura internacional, e constou das seguintes etapas: 1.Tradução; 2. Revisão da tradução por um grupo bilíngüe; 3. Retradução; 4. Avaliação da retradução; 5. Estudo piloto para testar a versão preliminar do instrumento, no qual foram entrevistados 14 moradores domiciliados próximos aos Serviços Residenciais Terapêuticos; 6. Revisão das questões a partir do estudo piloto. Resultados: Os resultados incluíram modificações importantes na formulação e no conteúdo das questões, para garantir a equivalência semântica e cultural da escala adaptada para o contexto brasileiro. A versão brasileira da CAMI (CAMI-BR), após cumpridas todas as etapas exigidas internacionalmente, desde a tradução até sua aplicação em população teste, resultou em escala de linguagem clara, compreensível e fácil aplicabilidade.

Negative attitudes towards mentally ill people are one of the most important problems that prevent the implementation of community ? based mental health care units. Some international studies demonstrated three factors which are associated with these community attitudes: 1- fear of people with mentally illness; 2- lack of knowledge about mental health services, and 3- stereotype of psychiatric patients. These factors continue to maintain barriers to the effective treatment and social reintegration of the psychiatric patients in the community. In Brazil, there are scarce studies about this issue. None of the Brazilian studies used the Community Attitudes Towards Mental Ill instrument (CAMI) to assess attitudes of population towards psychiatric patients living in the communities. The present study consists of a transcultural adaptation of the original instrument in English (CAMI) into a final version to be used in Brazil. Based on a broad literature review, the transcultural adaptation of the CAMI to the Brazilian context was made following the next steps: 1- Translation; 2- revision of the translation by 2 experienced bilingual professionals; 3- Back translation: A bilingual epidemiologist and a group of experienced bilingual professionals carried out the back translation 4- Assessment of the back translation; 5- Pilot Study: A sample of 14 residents was selected at random from the area of the community. 6- Analysis of the pilot study data. Results indicated a satisfactory equivalence between versions, with modifications being made in the procedures for conducting the interview and the language used in the questions. Our findings showed that the CMI-BR is an instrument which has clear instructions, understandable questions and easy application in the Brazilian context.

Influencia de dos factores en la percepción hacia los enfermos mentales; contacto cercano y educación en salud / Health education and close contact as factors involved in the attitude towards the mentally ill

Introduction: Either out of personal experiences, fear, or other reasons, people tend to stigmatize the mentally ill. This stigma affects in a negative manner these patients. Our primary objective was to evaluate the existence of differences in attitudes towards the mentally ill among different people, grouped according to four characteristics: health care providers, general population, people who know mentally ill, and those who do not. Methods: The Community Attitudes toward Mentally Ill Scale (CAMI) was applied to 126 participants, which were classified in four groups: "know-health", "do not know- health", "know-general population", "do not know-general population". Each scale item was analyzed for each of the groups: authoritarianism, benevolence, social restriction, and perception. Results: Health care providers report less authoritarianism, less social restriction, and better perception towards the mentally ill when compared to general population. Those who know a mentally ill also have a better perception and less social restriction than those who do not know a mentally ill patient. The positive effects on stigma reduction among health care providers and those who know mentally ill patients had an additive effect. Conclusion: When common people know a mentally ill, the stigma is diminished. This contributes to better support, leading to improved treatment and better prognosis.

Introducción: Existe un halo de estigmatización de los enfermos mentales, sea por prejuicio, experiencias personales, etc., que influye en ellos de forma negativa. Nuestro objetivo es estudiar si existen diferencias en la percepción de los enfermos mentales entre la población general y el área de salud y entre quienes conocen y no conocen a un enfermo mental. Métodos: Se aplicó la encuesta CAMI III (Community attitudes Toward mentally III) a 126 personas, quienes fueron separadas en cuatro grupos (conocen-salud, conocen-no salud, no conocen-salud, no conocen- no salud) analizándose cada ítem de esta encuesta: autoritarismo, benevolencia, restricción social y percepción de la salud mental en la comunidad en cada uno de ellos. Resultados: El área de la salud presenta menos autoritarismo y restricción social que la población general y una mejor percepción que esta última. Los conocedores de un enfermo mental presentan mejor percepción y menos restricción que quienes no los conocen. Conjuntamente, quienes conocen y trabajan en salud son menos autoritarios y restrictivos que quienes no conocen y no trabajan en salud, presentando éstos últimos una peor percepción que los primeros. Conclusión: La población en contacto cercano con pacientes mentales presenta menos conductas de estigmatización, ya sean trabajadores de salud, parientes o amigos cercanos. Esta menor estigmatización favorecería un mayor apoyo para estos pacientes, mejorando su tratamiento y pronóstico. Es importante la educación de la población sobre estos temas, de manera de disminuir el estigma.

A Study of Attitudes toward the Mentally Ill of Administration Clerks in Mental Hospitals:mparison between National Mental Hospitals and Private Mental Hospitals / 신경정신의학

OBJECTIVES: The purpose of this study is to investigate the attitudes toward the mentally ill, identify the factors influencing their attitudes of administration clerks in national and private mental hospitals, and to get basic data to develop education program and the strategy to treatment of mental illness. METHODS: Total 166 administration clerks working in the two national mental hospital and four private mental hospital were interviewed by Community Attitudes to the Mentally Ill (CAMI) scale. RESULTS: The administration clerks who working in the mental hospital showed generally sympathetic and positive attitudes in all CAMI scales like other community residents and mental health personnels. Administration clerks working in national mental hospitals showed more positive attitudes in authoritarianism subscale than those in private mental hospitals. Females who live in township areas (myeon), are low educated and have shorter duration of employment in national mental hospitals had relatively negative attitudes toward the mentally ill. Administration clerks working in private mental hospitals showed less significant differences according toward demographic characteristics. CONCLUSION: It will be necessary to give information and systematic education about mental health for those who have negative attitude toward mentally ill, especially in the early period of employment. Further investigations should include comparison between characteristics of administration clerks working in national and private mental hospitals and change in attitudes after systematic education.

A Study of Attitudes toward the Mentally Ill in Pohang Community / 신경정신의학

OBJECTIVES: The purpose of this study is to get basic data to develop plan and strategy of com-munity mental health in Pohang city by identifying attitudes toward mentally ill in Pohang community. METHODS: The subjects of this study are the 491 persons aged between 20 and 59 who live in Pohang. Methods of selection for the subjects based on multistage stratified cluster sampling, i.e. by sex, by age, by place of residence("Up", "Myeon", "Dong"), and by ratio to total populations. Tool of the study is Community Attitudes to the Mentally Ill Inventory(CAMI). RESULTS: 1) The residents of Pohang community showed positive attitude in 'Benevolence' and 'Community mental health ideology' subscale and negative attitude in 'Authoritarianism' and 'Social restric-tiveness' subscale. Therefore community mental health project in Pohang city will be established and activated easily. 2) Aged group had more authoritative, social restrictive and less community mental health oriented attitude. 3) The lower educated group had more authoritative, social restrictive and less benevolent, community mental health oriented attitude. 4) The unmarried group had less authoritative, less social restrictive attitude. 5) The home-owners had more authoritative, more social restrictive attitude. 6) The opinion leaders had more authoritative and less community mental health oriented attitude. 7) The respondents whose family had used mental health services had less benevolent attitude. The respondents who themselves had used mental health services had more authoritative, less benevolent and community mental health oriented attitude. CONCLUSIONS: Therefore, it will be necessary to give public information and education for those who have negative attitude groups of aged, low educated, home-owners, opinion leaders and respondents who themselves or whose family had used mental health services. If resource could be made of persons of positive attitude groups of younger aged, highly educated and unmarried, community mental health project will be more efficient.