Interventions to reduce the stigma of mental health at work: a narrative review

Abstract Background While there are reviews of the literature on mental health stigma reduction programs, very few have focused on the workplace. Objective: We sought to identify, describe and compare the main characteristics of the interventions to reduce the stigma towards mental health at work. Method The search of original articles (2007 to 2022) was carried out in the Web of Science Core Collection and Scopus databases, selecting 25 articles from the key terms: 1. Stigma, 2. Workplace, 3. Anti-stigma intervention/program, 4. Mental health. Results: These interventions can be effective in changing the knowledge, attitudes, and behaviors of workers towards people with mental health problems, although further verification of these results is needed as they are limited to date. Discussion and conclusion Interventions to reduce stigma in the workplace could create more supportive work environments by reducing negative attitudes and discrimination and improving awareness of mental disorders.

Evaluación del estigma hacia personas con diagnóstico de esquizofrenia mediante una escala de conocimiento / Evaluation of the stigma towards people with a diagnosis of Schizophrenia using a Knowledge Scale

RESUMEN Introducción: El estigma público es la adscripción de estereotipos negativos a las personas con diagnóstico de esquizofrenia. Se han utilizado distintos instrumentos para evaluarlo, entre los que destacan las escalas de conocimiento. El objetivo del estudio es evaluar el estigma público a través de una medida de conocimiento y relacionar el nivel de información con variables con demostrada influencia en el estigma que presenta la población. Métodos: La muestra fue de 399 personas; el criterio de inclusión fue tener entre 18 y 65 arios. Se aplicó el Cuestionario de conocimiento sobre la esquizofrenia y un instrumento para recolectar información sociodemográfica. Los participantes fueron reclutados en lugares de gran afluencia de público. Se realizaron análisis de correspondencias múltiples no paramétricos bivariables y de conglomerados jerárquicos. Resultados: El cuestionario presenta dos dimensiones: «Creencias sobre el conocimiento de la esquizofrenia¼ y «Actitudes hacia la esquizofrenia¼; existen diferencias significativas entre estas y el contacto con personas con un trastorno mental grave. En el análisis por conglomerados, se encontraron 3 grupos diferenciados en función de la combinación de las 2 dimensiones del instrumento. Conclusiones: Destaca que ninguna de las 2 dimensiones mide conocimiento veraz, y el cuestionario tiene una dimensión actitudinal. Más que el contacto en sí, es el tipo de interacción una variable relevante en el nivel de estigma, lo que cuestiona la hipótesis tradicional del contacto. Se requiere investigar mejor las características del instrumento y los aspectos del contacto que se asocian a un menor nivel de estigma en la población.

ABSTRACT Introduction: Social stigma is the assigning of negative stereotypes to people with schizophrenia. Different measurement tools have been used to evaluate this, including knowledge scales. The aim of this study was to evaluate the public stigma by measuring this knowledge and relate the degree of information with variables that have shown to influence on stigma presented by the affected population. Methods: The sample was composed of 399 people and the inclusion criterion was being between 18 and 65 years of age. The "Questionnaire of knowledge on schizophrenia" was applied, as well as a questionnaire to collect sociodemographic information. Participants were recruited in places with large crowds. The following analyses were performed: multiple correlations, non-parametric bivariate and hierarchical clusters. Results: The questionnaire had two dimensions: "Beliefs on the knowledge of schizophrenia" and "Attitudes towards schizophrenia". There are significant differences between them, and the contact with people with SMI. In the analysis of clusters, there was difference in the two groups according to the combination of the two dimensions of the tools. Conclusions: It is highlighted that none of the dimensions measures true knowledge, and the questionnaire has an attitudinal dimension. More than contact itself, it is the type of interaction of a relevant variable at the level of stigma that questions the traditional hypothesis of contact. Further research is required on the characteristics of the tool and the aspects of the contact associated to a lower level of stigma in the population.

Integrated mapping of local mental health systems in Central Chile / Mapeo integrado de los sistemas locales de salud mental en la zona central de Chile / Mapeamento integrado dos sistemas locais de saúde mental na região central do Chile

ABSTRACT Objective To describe the availability of local mental health (MH) services in small MH catchment areas in Central Chile, using a bottom-up approach. Methods MH services of 19 small MH catchment areas in five health districts of Central Chile that provide health care to more than 4 million inhabitants were assessed using DESDE-LTC (Description and Evaluation of Services and Directories in Europe for Long-Term Care), a tool for standardized description and classification of LTC health services, in a study conducted in 2012 ("DESDE-Chile") designed to complement other studies conducted in 2004 and 2012 at the national and regional level using the World Health Organization Assessment Instrument for Mental Health Systems (WHO-AIMS). Key informants from national, regional, and local health authorities were contacted to compile a comprehensive list of MH services or facilities (health, social services, education, employment, and housing). The analysis of local care provision covered three criteria—service availability, placement capacity, and workforce capacity. Results The study detected disparities in all three criteria (availability and placement and workforce capacity) across the five health districts, between urban and rural areas, and between neighboring urban areas. Analysis of service availability revealed differences in the weight of residential services versus day and outpatient care. The Talcahuano area could be considered a benchmark of MH care in Central Chile, based on its service provision patterns, and the criteria of the community care model. The list of MH services identified in this study differed from the one generated in the 2012 WHO-AIMS study. Conclusions This survey of local MH service provision in small catchment areas using the DESDE-LTC tool provided MH service provision data that complemented information collected in other studies conducted at the national/regional level using the WHO-AIMS tool. The bottom-up approach applied in this study would also be useful for the assessment of equity and accessibility and local planning.

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RESUMO Objetivo Descrever a disponibilidade de serviços locais de saúde mental em pequenas áreas de cobertura de saúde mental na região central do Chile com o uso de uma abordagem de baixo para cima (bottom-up). Métodos Os serviços de saúde mental de 19 pequenas áreas de cobertura de saúde mental em cinco distritos de saúde da região central do Chile que prestam assistência de saúde a mais de 4 milhões de habitantes foram avaliados com o uso da ferramenta DESDE-LTC (Description and Evaluation of Services and Directories in Europe for Long-Term Care - descrição e avaliação de serviços e diretórios na Europa para atenção a longo prazo). Trata-se de uma ferramenta para descrição padronizada e classificação dos serviços de saúde de assistência de longo prazo. Os dados desta avaliação foram comparados aos de um estudo de 2012 (DESDE-Chile) realizado com a finalidade de complementar outros estudos conduzidos em 2004 e 2012 ao nível nacional e regional com o uso do Instrumento de Avaliação dos Sistemas de Saúde Mental da Organização Mundial da Saúde (WHO-AIMS). Neste estudo, foi solicitado aos informantes-chave das autoridades de saúde ao nível nacional, regional e local que fizessem uma relação completa dos serviços ou instituições de saúde mental (das áreas da saúde, assistência social, educação, trabalho e habitação). A prestação de assistência local foi analisada segundo três critérios: disponibilidade de serviços, capacidade de vagas e capacidade da força de trabalho. Resultados O estudo verificou, nos cinco distritos de saúde, disparidades nos três critérios (disponibilidade e vagas e capacidade da força de trabalho) entre a zona urbana e rural e entre áreas urbanas vizinhas. A análise da disponibilidade de serviços revelou diferenças no peso entre os serviços residenciais e os serviços de assistência ambulatorial e atenção diária. Talcahuano poderia ser considerada a área de referência em atenção de saúde mental na região central do Chile, segundo os padrões de prestação de serviços e os critérios do modelo de atenção de base comunitária. A lista de serviços de saúde mental identificados no estudo difere da lista compilada no estudo de 2012 com o uso da WHO-AIMS. Conclusões Esta pesquisa sobre a prestação local de serviços de saúde mental em pequenas áreas de cobertura com o uso da ferramenta DESDE-LTC proporcionou dados que complementaram os dados coletados em outros estudos realizados ao nível nacional e regional com o uso da ferramenta WHO-AIMS. A abordagem de baixo para cima empregada neste estudo também poderia ser útil na avaliação de equidade e acessibilidade e do planejamento local.

Inventario de Conductas Infantiles en preescolares: propiedades psicométricas del Inventario de Conductas Infantiles (CBCL/1. 5-5) y del informe del cuidador/educador (C-TRF) en preescolares chilenos / Psychometric properties of the Child Behavior Checklist and the caregiver /teacher report form in Chilean preschoolers

El Inventario de Conductas Infantiles 1.5-5 años (CBCL/1.5-5 por su acrónimo en inglés) y el informe del cuidador/educador (C-TRF por su acrónimo en inglés), son de los instrumentos más ampliamente reconocidos internacionalmente para evaluar conductas desadaptativas que pueden afectan el desarrollo presente y futuro de niños y niñas preescolares. Se evaluó el comportamiento psicométrico de ambos instrumentos en una muestra diversa socioeconómicamente de 550 preescolares chilenos. En general, ambos mostraron un comportamiento psicométrico análogo al obtenido con estudios en otras sociedades. Los análisis factoriales confirmatorios mostraron un ajuste adecuado del modelo bifactorial original. Sin embargo, en el CBCL/1.5-5 los puntajes obtenidos son más altos que en la mayoría de los países y, comparativamente, en ambos instrumentos, se observó un mayor efecto de género. Se analizan los hallazgos obtenidos, y se dan sugerencias normativas y conceptuales para el empleo de ambos instrumentos en niños y niñas preescolares en nuestro país.

The child Behavior checklist/1.5-5 and the caregiver/teacher report Form are one of the most widely internationally recognized instruments to evaluate desadaptative behaviors which may affect the current and future development of preschool children. The psychometric behavior of both instruments was evaluated in a socioeconomically diverse sample of 550 chilean preschool children. In general, it was observed an analog behavior of both compared to the one obtained with studies in other societies. The confirmatory factor analysis showed a suitable adjustment of the original bifactor model. However, in the CBCL, the scores obtained are higher than in most of the countries and, comparatively, in both instruments, a greater effect of gender was observed. The findings obtained are analyzed and, normative and conceptual suggestions are given for the use of both instruments in preschool children in our country.

Investigación en servicios de salud mental en Chile: avances y desafíos / Research on mental health services in Chile: progress made and pending challenges

Los procesos de reestructuración de los servicios de atención en salud mental, han abierto el espacio a la investigación sobre la llamada epidemiología de servicios. En este artículo se discuten los límites de este ámbito de investigación, su relación con la gestión, y los modelos que han permitido su desarrollo. Asimismo, se revisan resultados de investigaciones nacionales en las distintas dimensiones, siguiendo el modelo de Matriz de Salud Mental de Thornicroft y Tansella (1999), la complementariedad de la información, los avances y desafíos.

Re-modelling mental health services has opened the way for research on the so-called healthcare epidemiology. This article discusses the limits of this research field, its relationship with management and mentions the models that have made possible its development. Likewise, results from national studies are reviewed that cover different dimensions in accordance with the The Mental Health Matrix (Thornicroft and Tansella, 1999), information complementarity, and progress made and pending challenges.

Patología psiquiátrica en familiares de pacientes esquizofrénicos / Psychiatric phatology in schizophrenic patients' families

En el marco del estudio prospectivo transcultural denominado "El pronóstico de la esquizofrenia en Chile", se presentan los resultados más relevantes sobre la prevalencia de trastornos psiquiátricos en 156 familiares de pacientes esquizofrénicos. La prevalencia combinada para los trastornos CIDI/DSM-III-R encontrada es de 35,3 por ciento. La prevalencia de vida para los trastornos esquizofrénicos alcanza a un 5,1 por ciento. Los resultados se comparan con estudios similares realizados en el extranjero y con estudios nacionales de población general