Understanding and navigating the repercussions of the politically polarized climate in mental health

Abstract The world is experiencing a moment of political polarization between liberal and conservative ideas, which has aggravated since the arrival of the Covid-19. Many countries (Brazil included) have been experiencing the generalized occurrence of people fighting over politics, in contexts including family, workplace, friendships, and romantic relationships. Over the past 2 years, it has been possible to observe an unexpected and overwhelming effect of the political climate on psychotherapy patients, some of whom have started to actively look for therapists who share their convictions. Brazil is experiencing a moment of severe sanitary, economic, social, and political crisis, which is directly affecting our patients. Nevertheless, the impact of the political climate on our population has not been systematically investigated. However, as the political environment is an inherent part of the social component of the psychosocial model, it is important that mental health professionals be prepared to have this conversation with their patients. This highlights the need to address these difficulties in supervision, rounds, and clinical discussions.

A Psychosocial Occupational Stress Modal Among Academic Employees In Thai Government Universities Under Job Conditions

Psychosocial occupational stress is one of the health hazards in the workplace in the view of occupational health. The aim of this study was to analyze a psychosocial occupational stress model among academic employees in Thai government universities under job conditions, Thailand. Primary data were collected from 500 academic employees in Thai government universities using stratified random sampling. The relationship between stress and tasks among academic employees in Thai government universities under normal job conditions was verified using a psychosocial occupational stress model. The results found that teaching and researching tasks had a direct effect on stress with standardized regression weights of 0.279 and 0.186, respectively (p-value < 0.01). In addition, teaching tasks had a negative relationship with academic service tasks with standardized regression weights of -0.199 (p-value < 0.01). At the same time, teaching tasks also had an indirect effect on stress through academic service tasks. Academic service tasks had a direct effect on stress with standardized regression weights of 0.098 (p-value < 0.05). By contradiction, the cultural preservative task did not have direct effect on stress (no significance). In addition, this model under normal job conditions is an appropriate model to describe the stress among academic employees in Thai government universities under job conditions because it indicated a very close fit and an excellent goodness of fit index. This psychosocial occupational stress model displayed that teaching tasks had the most direct effect on stress among academic employees in Thai government universities under job conditions.

Reduction of maternal mortality due to preeclampsia in Colombia - an interrupted time-series analysis / Reducción de la mortalidad materna por preeclampsia en Colombia - un análisis de series de tiempo interrumpido

Abstract Introduction. Preeclampsia is the most important cause of maternal mortality in developing countries. A comprehensive prenatal care program including bio-psychosocial components was developed and introduced at a national level in Colombia. We report on the trends in maternal mortality rates and their related causes before and after implementation of this program. Methods: General and specific maternal mortality rates were monitored for nine years (1998-2006). An interrupted time-series analysis was performed with monthly data on cases of maternal mortality that compared trends and changes in national mortality rates and the impact of these changes attributable to the introduction of a bio-psychosocial model. Multivariate analyses were performed to evaluate correlations between the interventions. Results: Five years after (2002-2006) its introduction the general maternal mortality rate was significantly reduced to 23% (OR= 0.77, CI 95% 0.71-0.82).The implementation of BPSM also reduced the incidence of preeclampsia in 22% (OR= 0.78, CI 95% 0.67-0.88), as also the labor complications by hemorrhage in 25% (OR= 0.75, CI 95% 0.59-0.90) associated with the implementation of red code. The other causes of maternal mortality did not reveal significant changes. Biomedical, nutritional, psychosocial assessments, and other individual interventions in prenatal care were not correlated to maternal mortality (p= 0.112); however, together as a model we observed a significant association (p= 0.042). Conclusions: General maternal mortality was reduced after the implementation of a comprehensive national prenatal care program. Is important the evaluation of this program in others populations.

Resumen Introducción. La preeclampsia es la causa más importante de mortalidad materna en los países en desarrollo. Se desarrolló e introdujo en Colombia y a nivel nacional un programa de cuidado prenatal que incluyó componentes bio-psicosociales. Se muestran las tendencias de las tasas de mortalidad materna y las causas relacionadas antes y después de la implementación del programa. Métodos: Las tasas de mortalidad general y específica fueron monitoreadas durante 9 años (1998-2006). Un análisis de series de tiempo ininterrumpido se realizó con datos mensuales de casos de mortalidad materna y se compararon las tendencias de cambio en las tasas de mortalidad nacional y el impacto de los cambios atribuibles a la introducción del modelo. Se hizo un análisis multivariado para evaluar la asociación entre las intervenciones. Resultados: Cinco años después de la introducción del programa (2002-2006) la tasa de mortalidad maternal se redujo significativamente en 23% (OR= 0.77, CI 95% 0.710.82). La implementación del MBPS redujo la incidencia de la preeclampsia en 22% (OR= 0.78, CI 95% 0.67-0.88 , igual la mortalidad materna por complicación del parto por hemorragias en 25% (OR= 0.75, CI 95% 0.59-0.90). Otras causas de mortalidad materna no mostraron cambios significativos. No se correlacionó la mortalidad materna con intervenciones de cuidado prenatal individuales como las biomédicas, nutricionales y psicosociales (p= 0.112), sin embargo, ellas en conjunto como un modelo (biopsicosocial) si observaron una asociación significativa (p= 0.042). Conclusiones: La mortalidad maternal general se redujo después de la implementación de un programa nacional de cuidado prenatal. Es importante evaluar este programa en otras poblaciones.

Self-rated health: importance of use in elderly adults / Auto-percepción de salud: importancia de su uso en adultos mayores

Introduction: The concept of self-rated health (SRH) was conceived during the first half of the twentieth century. Since then, numerous studies have documented the validity of its measurement and it has been widely accepted as a reliable measurement of overall health. SRH is considered a subjective measurement integrating the biological, mental, social, and functional aspects of an individual. Objective: To review the literature to determine theoretical determinants, related outcomes, and utility of SRH in elderly adults (EAs). Methods: The databases reviewed were Medline, SciELO, EMBASE, Science Direct, Proquest, and Ovid, along with information available in websites from international health agencies. Results: SRH is considered a sensitive measurement of overall health in EAs. It is influenced by physical function, the presence of disease, the existence of disabilities, functional limitations, and by the rate of aging. Many studies suggest it may be modified by demographics, as well as by social and mental factors. Thus, the perception of health is the result of multiple and complex interactions of variables determining it at any given time. SRH is based on systems theory and the bio-psychosocial health model. It has proven to be a significant independent predictor for development of morbidity, mortality, and disability in basic physical and instrumental daily life activities among elderly adults. Conclusion: In addition to reflecting the overall health status of EAs, SRH can provide information to aid health personnel and decision makers in the development and implementation of health promotion and disease prevention programs, as well as the adequacy and planning of different levels of care for this population.

Introducción: El concepto de auto-percepción de salud (APES) fue introducido a mitad del siglo XX. Desde entonces, numerosos estudios han documentado la validez de su medición y ha sido ampliamente aceptado como una medida confiable del estado de salud general. La APES se considera una medición subjetiva que integra factores biológicos, mentales, sociales y funcionales del individuo. Objetivo: Realizar una revisión de la literatura para determinar fundamentos teóricos, factores determinantes, desenlaces relacionados y utilidad de la APES en adultos mayores (AM). Metodología: Se utilizaron las bases de datos Medline, SciELO, EMBASE, Science Direct, Proquest, Ovid, así como la información disponible en sitios web de organismos sanitarios internacionales. Resultados: La APES se considera una medida sensible del estado general de salud en los AM. Está influida por la función física, la presencia de enfermedades, la existencia de discapacidades, de limitaciones funcionales y por el tipo de envejecimiento. Muchas investigaciones sugieren que la pueden modificar variables demográficas, sociales y mentales. De esta manera, la APES es la resultante de múltiples y complejas interacciones de variables que la determinan en un momento dado. La APES se fundamenta en la teoría de sistemas y en el modelo bio-psicosocial de salud. Se ha demostrado que se comporta como un predictor independiente y significativo para desarrollar morbilidad, mortalidad y discapacidad, tanto en las actividades básicas cotidianas como en los aspectos físico e instrumental en adultos mayores. Conclusión: La APES además de reflejar el estado de salud global del AM, puede brindar información que ayude al personal de salud y a tomadores de decisiones en el desarrollo e implementación de programas de promoción de la salud y prevención de la enfermedad, así como en la adecuación y planificación de diferentes niveles asistenciales para este grupo poblacional.

Modelo biopsicossocial e formulação comportamental: compreendendo a cefaléia do tipo tensional / Modelo biopsicosocial y formulación comportamental: comprendiendo la cefalea del tipo tensional / The bio-psychosocial model and behavioral formulation: understanding the tension-type headache

A cefaléia do tipo tensional constitui um tipo freqüente de dor de cabeça, que tende a ocasionar uma série decomportamentos de evitação, com prejuízos físicos, sociais e psicológicos aos indivíduos afetados. O presente trabalhodescreve algumas contribuições do modelo biopsicossocial de saúde para a compreensão da cefaléia do tipo tensional,descreve os tratamentos mais freqüentemente oferecidos e discute as vantagens de modalidades terapêuticas que utilizam aformulação comportamental. Destaca-se a relevância da consideração de fatores psicossociais presentes nas formas maiscomuns de evolução da cefaléia do tipo tensional, o que contribui para a elaboração de planos de tratamento mais eficientes ecoerentes com uma proposta realmente sistêmica e idiográfica.

Tension-type headache are a frequent source of complaints in health assistance units. It tends to cause avoidancebehaviors with adverse consequences in physical, psychological and social aspects. Contributions from the Bio-Psychosocialperspective are described for a better understanding of the tension-type headache problem. Study also analyzes the mostfrequent treatments used in clinical settings and discusses some advantages of behavioral cases formulations. Results revealthe importance of behavioral and social factors present in the complex etiology of tension-type headache. Such knowledge isuseful to support the formulation of more efficient treatments that are linked to a real systemic and idiographic perspective.

Abordagem construtivista no desenvolvimento de competências psicossociais para a assistência domiciliar / Constructivist approach in the development of psychosocial competences for home care

O investimento dessa pesquisa, de natureza qualitativa, foi colocar em evidência a Assistência Domiciliar (AD) na interface entre a capacitação e a prática profissional, articulando-se a abordagem construtivista, o referencial do modelo psicossocial e métodos psicodramáticos. Os objetivos foram: propor referenciais teóricos para um modelo de atenção voltado para a assistência domiciliar, considerando a dimensão psicossocial; implementar um curso de capacitação para profissionais de saúde que atuam na assistência domiciliar, numa abordagem construtivista; identificar as mobilizações nos sistemas de conceitos e nos esquemas de ação decorrentes dessa programação. O curso de capacitação foi construído em três tempos: no do reconhecimento dos sujeitos e da mobilização afetiva; no da mobilização de conceitos e das representações das práticas profissionais; no da aplicabilidade do modelo psicossocial, através da consulta profissional. Foi ministrado na Escola de Enfermagem da USP, para sete profissionais de nível superior e com experiência na AD. Para verificar a mobilização dos conceitos e das práticas profissionais usaram-se os pressupostos de Vygotsky. Os dados evidenciaram que houve mobilização dos afetos e dos conceitos da abordagem psicossocial e que a consulta profissional foi viável. As situações práticas apresentadas tiveram como foco as relações interpessoais e os dilemas próprios da condição humana. A incompletude, na internalização do processo, permite considerar que as participantes não acomodaram o novo referencial aos esquemas de pensamento e de ação pregressos, projetando iniciativas ainda incipientes de reformulações, o que requer novos investimentos.

The purpose of this qualitative research was to show the interface of education, training and practice in home care. The research combined the constructivist approach, the theoretical psychosocial model and methods of psychodrama. The objectives were: to propose theoretical framework that can be applied to home care, taking in account its psychosocial dimension; to implement training and education, based on the constructivist approach, for healthcare professionals which work in homecare; to identify the mobilizations in conceptual framework and in projects resulting from this program. The course consisted of three stages: recognition of the subjects and of the affective mobilization; mobilization of the concepts and of the representations of professional practices; applicability of the psychosocial model through professional consultations. It was offered, at the University of São Paulo School of Nursing, for seven university graduates with experience in home care. The assumptions of Vygotsky were used to verify the mobilization of the concepts and the professional practices. The data showed that there was a mobilization of affection and concepts of the psychosocial approach and that the professional consultation was viable. The practical situations presented focused on interpersonal relationships and the dilemmas of the human condition. The incompleteness of the internalization process allows us to consider that the participants did not assimilate the new reference of the conceptual framework or the previous action, creating initiatives which are still in their initial phase that require further study

The Crisis of Psychiatry: Psychiatric Patients, Quo Vadis? / 신경정신의학

In the year two thousand and following years, there will be tremendous changes in the field of psychiatry. At this critical period, we should rethink the identity of psychiatry. The characteristics and problems of psychiatry in the near future include a) 'mindless' psychiatry confined into the brain cell, b) a continuous evolution of non-psychiatric practitioners, medical or nonmedical, c) the atrophy of psychiatric practice due to economic pressure by society, and d) psychiatric policy of functional diagnostic criteria and guidelines in practice. The above situations can result in a) the more superficial and easy going attitude of psychiatry in practice, b) superficial understanding of patients and inadequate treatment outccome, c) patients' frustration and seeking help from alternative or quasi-practitioners, and tele-psychiatry or cyber space. Psychiatrists' recognition of a crisis, active coping with the problems and harmonized and integrated education were suggested for the better contribution.