[Models for primary care and mental health collaboration in the care of people with depression: main results and methodological challenges of a systematic overview]. / Modelos de colaboración entre atención primaria y salud mental en la asistencia sanitaria a las personas con depresión: resultados principales y retos metodológicos de una meta-revisión sistemática.

BACKGROUND: Weaknesses in the collaboration between Primary Care (PC) and Mental Health (MH) are a relevant problem in the care of depressed patients. It is necessary to analyse and appraise the existing models of collaboration to assess their applicability to the Spanish Health System. The aim of this study is to know the main characteristics of the different models of collaboration between PC and MH in the care of patients with depression and the quality of their effectiveness evidence. METHODS: Systematic overview of secondary studies published from 2001 to 2010 in MEDLINE, PsycINFO, Embase, LILACS, IBECS, IME and The Cochrane Library. Assessment of reviews applying the AMSTAR tool. Approximative synthesis of the quality of evidences. RESULTS: A total of 69 studies were assessed. Quality of evidences is generally low or inconclusive due to the great variability among contexts and the methodological weaknesses. The most effective strategies integrate interventions for assigning responsibility for patient follow-up, redesigning management and communication/information sharing. Overviews of secondary studies on collaborative models facilitate access to published evidence, but entail important methodological challenges. CONCLUSION: The quality of evidences on effectiveness of PC-MH collaboration models in depression care is mainly low or inconclusive, and the more simplified are the analysis of components, processes and implementation conditions, the less meaningful and applicable they are.

Modelos de colaboración entre atención primaria y salud mental en la asistencia sanitaria a las personas con depresión: resultados principales y retos metodológicos de una meta-revisión sistemática / Models for primary care and mental health collaboration in the care of people with depression: main results and methodological challenges of a systematic overview

Fundamentos: Las carencias en la colaboración entre Atención Primaria (AP) y Salud Mental (SM) constituyen un problema relevante en la atención a los pacientes con depresión. Resulta necesario analizar y evaluar los modelos de colaboración existentes para valorar su aplicabilidad en el sistema de salud español. El objetivo del presente estudio es conocer las principales características de los distintos modelos de colaboración AP-SM en la atención a los pacientes diagnosticados de depresión y la calidad de la evidencia científica acerca de su efectividad. Métodos: Meta-revisión sistemática de los estudios secundarios publicados entre 2001 y 2010 en MEDLINE, PsycINFO, Embase, LILACS, IBECS, IME y la Biblioteca Cochrane. Las revisiones se evaluaron mediante la herramienta AMSTAR. Se realizó una síntesis aproximativa de la calidad de las evidencias encontradas. Resultados: Se evaluaron 69 estudios. La variabilidad según contextos y las carencias metodológicas condicionan que la calidad de las evidencias sea en general baja o dudosa. Las estrategias más efectivas integran intervenciones de responsabilización en el seguimiento de los pacientes, rediseños en la gestión, e información y comunicación compartidas. Las meta-revisiones de estudios secundarios sobre modelos colaborativos favorecen la accesibilidad a las evidencias publicadas, pero conllevan importantes retos metodológicos. Conclusiones: La calidad de la evidencia sobre la efectividad de los modelos de colaboración AP-SM durante la atención sanitaria a las personas con depresión es predominantemente baja o dudosa y su significado y aplicabilidad son menores cuanto más se simplifica el análisis de sus componentes, procesos y circunstancias de implementación (AU)

Background: Weaknesses in the collaboration between Primary Care (PC) and Mental Health (MH) are a relevant problem in the care of depressed patients. It is necessary to analyse and appraise the existing models of collaboration to assess their applicability to the Spanish Health System. The aim of this study is to know the main characteristics of the different models of collaboration between PC and MH in the care of patients with depression and the quality of their effectiveness evidence. Methods: Systematic overview of secondary studies published from 2001 to 2010 in MEDLINE, PsycINFO, Embase, LILACS, IBECS, IME and The Cochrane Library. Assessment of reviews applying the AMSTAR tool. Approximative synthesis of the quality of evidences. Results: A total of 69 studies were assessed. Quality of evidences is generally low or inconclusive due to the great variability among contexts and the methodological weaknesses. The most effective strategies integrate interventions for assigning responsibility for patient follow-up, redesigning management and communication/information sharing. Overviews of secondary studies on collaborative models facilitate access to published evidence, but entail important methodological challenges. Conclusion: The quality of evidences on effectiveness of PC-MH collaboration models in depression care is mainly low or inconclusive, and the more simplified are the analysis of components, processes and implementation conditions, the less meaningful and applicable they are (AU)

Conditions that do not reach the threshold for mental disorder in Spanish psychiatric outpatients: prevalence, treatment and management.

BACKGROUND: In recent years there has been controversy around the treatment demands of people who, without meeting diagnostic criteria for a mental disorder, have certain symptoms and are referred to mental health professionals. AIMS: To determine the prevalence of individuals assessed by mental health service, referred from primary care, who do not meet the diagnosis criteria of mental disorders according to ICD-10. To analyze the medical treatment given to these individuals, measured by the indication for discharge or follow-up and by the pharmacological intervention decided in the first interview, as well as the associated variables. DESIGN: descriptive study. SCOPE: urban area. POPULATION: all patients referred to the Salamanca mental health service during a year, without any exclusion (n = 1,187). VARIABLES: sociodemographics; clinical and health service utilization gathered through clinical interview, GHQ-28, SCL-90-R and an expectations scale. RESULTS: Of the 1,004 patients who attended interview, 24.4% (CI 95%: 21.6-27.0) did not present any diagnosable mental disorder (Z codes); they constitute the body of this study. 50.8% of these were referred from primary care with a psychotropic drug treatment already prescribed. Any drug intervention (addition, suspension or modification) was performed in 37.2% of the cases by the mental health service. Regardless of the treatment indicated, 52% were discharged after the first interview. CONCLUSIONS: The prevalence of patients who failed to reach diagnostic criteria for a mental disorder in this health service is similar to other studies, in spite of the filter provided by primary care. Many individuals without a diagnosable mental disorder received treatment both in primary care and in the mental health service.

¿Dónde se encuentra la prevención y promoción de la salud mental en el momento actual? / What about prevention and promotion of mental health in current days?

Análisis y evolución histórica en las últimas décadas en prevención primaria y promoción de la salud. Propuestas para investigaciones futuras (AU)

Analyse and historic evolution in the last decades about the primary prevention and promotion of mental health. Various proposals for future researchs (AU)

Las consultas en un centro de salud mental sin trastornos mental diagnosticable / Mental health center consultations not attributable to diagnosable mental disorder

Objetivo: Determinar la incidencia de las personas mayores sin trastornos mental diagnosticable que consultan en un centro de salud mental y describir sus características sociodemográficas, asistenciales y clínicas. Metodología: Se evaluaron clínicamente a todos los pacientes nuevos (n=1.004) que acudieron consecutivamente, sin excluir a ninguno, durante un año, a un centro de salud mental para determinar cuál es la incidencia de aquéllos que no pueden ser diagnosticados de un trastorno mental según la CIE 10 (códigos Z). Además se obtuvo información sobre sus características sociodemográficas, asistenciales y clínicas mediante la entrevista clínica, un protocolo de recogida de información, una escala de expectativas, el GHQ-28, el SCL-90-R y una escala de acontecimientos vitales (CSV). Resultados: El 24,4% de los pacientes nuevos no fueron diagnosticados como trastornos mentales y se les registró como códigos Z. La idea de consultar en salud mental correspondió mayoritariamente al paciente o su familia y no a médico de atención primaria. La mitad tenían pautado un tratamiento farmacológico antes de consultar. El 52% fueron dados de alta del centro de salud mental tras la primera entrevista. Conclusiones: Las consultas sin trastornos mental diagnosticable en los servicios de salud mental son un fenómeno relevante que tiene grandes implicaciones en la realidad asistencial. Estas consultas suponen cuantitativamente una buena parte de la actividad clínica de los centros de salud mental, por lo que es imprescindible conocer cuál puede ser la mejor respuesta para que estas personas reciban la mejor ayuda sin perjuicio del sistema sanitario

Objective: Todetermine the incidence of persons with no diagnosable mental disorder who go for consulation in a mental health center and to describe their socio-demographic, clinical, and medical care patterns. Method: Consecutively and without exeptions, all persons (n=1004) going for first-time consultation in a mental health center in the course of a year were clinically examined for mental disorder. Those with no diagnosable mental disorder were registeres with a Z code. In addition, information about their socio-demographic and, clinical characteristics as well as their medical care patterns was collected through a clinical interview, a medical record, and expectancy scale, the GHQ-28, the SCL-90-R, and a life events scale (CSV). Results: Of the persons examined, 24.4% were not diagnosed with mental disorders and so were registered as having only a Z code. The initiative of seeking help in a mental health center was generally either the patient´s own or his family´s, not a general practitioner´s. Half of them were already receiving some kind of a drug therapy before their first visit. Over half of these patients (52%) were discharge after the first interview. Conclusions: Recourse to mental health services in the absence of diagnosable mental disorder is a phenomenon that has much bearing on the effectiveness of the health care system. These consultations amount to a considerable percentage of clinical activity in mental health center. It is important to figure out how these people can receive adequate attention without prejudice the health care system

Ausencias en las primeras consultas de un centro de salud mental: un estudio controlado / No attendance to initial appointments in a Mental Health Care: a controlled study

Se analizan los factores que intervienen en las ausencias a las primeras consultas en un Centro de Salud Mental desde los tres grupos que los definen: atención primaria, el paciente y el centro de salud mental. La edad del paciente, la celeridad en la derivación y la lista de espera son las variables más importantes que influyen en este fenómeno (AU)