[Desigualdades de género en el consumo de ansiolíticos e hipnosedantes por parte de adolescentes en España: un estudio transversal.] / Gender inequalities in the consumption of anxiolytics and hypnosedatives by adolescents in Spain: a cross-sectional study.

OBJECTIVE: There is increasing evidence of deterioration in the mental health of the population, especially among women and adolescents. We aimed to analyze gender inequalities in the consumption of anxiolytics and hypnosedatives (AHS) among adolescents in Spain in 2021 and its time trend, from an intersectional approach. METHODS: We conducted a cross-sectional study of time trends based on the ESTUDES national survey (n=22,321), comprising students between the ages of fourteen and eighteen. We calculated prevalences, prevalence ratios (PR) and interaction terms for consumption (both ever and in the last year), based on robust variance Poisson models, by sex, age, place of origin and parents' educational level. We also examine trends in consumption between 2010 and 2021. RESULTS: Female students showed higher consumption in all categories of the studied variables, together with a higher probability of use (PRvital=1.56 [1.47-1.64] and PRannual=1.81 [1.69-1.94]). Likewise, consumption increased with age, more pronounced in the case of male students (18 years old: PRvital=1,93 1,62-2,28]). Place of origin showed no statistically significant differences in AHS consumption. Lower educational level of parents predicts higher consumption among daughters, with mothers´ educational level showing a stronger association. Consumption increased over the 11-year period, and was consistently higher among women. CONCLUSIONS: We observe inequalities by gender and parents' educational level in AHS use among adolescents in Spain. It is critical to apply the model of the social determinants of health, which will lead to effective interventions in public health.

OBJECTIVE: Existen cada vez mayores indicios del deterioro en la salud mental de la población, especialmente en mujeres y adolescentes. El objetivo del estudio fue analizar las desigualdades de género en el consumo de ansiolíticos e hipnosedantes (AHS) por parte de adolescentes en España en 2021, además de su tendencia temporal, aplicando un análisis interseccional. METHODS: Se realizó un estudio transversal de tendencia temporal partiendo de la encuesta de ámbito estatal ESTUDES (n=22.321), con una muestra de estudiantes de catorce a dieciocho años. Se calcularon prevalencias, razones de prevalencia (RP) y términos de interacción del consumo alguna vez en la vida y en el último año, a partir de modelos de Poisson de varianza robusta (según sexo, edad, lugar de origen y nivel educativo de los progenitores). Asimismo, se realizó un análisis temporal del consumo (2010-2021). RESULTS: Las chicas presentaron mayores consumos en todas las categorías de las variables estudiadas, junto con una mayor probabilidad de uso (RPvital=1,56 [1,47-1,64] y RPanual=1,81 [1,69-1,94]). El consumo aumentó con la edad, de manera más pronunciada en los chicos (dieciocho años: RPvital=1,93 [1,62-2,28]). No existieron diferencias estadísticamente significativas según el lugar de origen. El descenso del nivel educativo de los progenitores aumentó significativamente el consumo en las hijas, con mayor impacto de los estudios maternos. La tendencia de consumo fue creciente, siendo superior en chicas durante toda la serie. CONCLUSIONS: El género o el nivel educativo de los progenitores determina de manera desigual el consumo de AHS entre los/las adolescentes en España. Es necesario ahondar en los determinantes sociales de la salud, dando lugar a intervenciones más efectivas en salud pública.

[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)

Los "otros profesionales" en la atención a personas con depresión: psicólogos, trabajadores sociales y enfermeras / The "other professionals" in the care of people with depression: Psychologists, social workers and nurses

Objetivos: Conocer las vivencias y perspectivas de psicólogos (P), trabajadores sociales (TS) y personal de enfermería (DUE) acerca de su papel en la atención al paciente con depresión. Método: Investigación cualitativa con diseño exploratorio y generación de información mediante dos grupos de discusión. Análisis temático y comparación de los hallazgos con un estudio previo con médicos de familia y psiquiatras. Triangulación entre investigadores. Resultados: El desconocimiento recíproco, la falta de coordinación, la borrosidad del diagnóstico y el riesgo de psiquiatrización aparecen como vivencias compartidas. Se subraya la importancia de lo biopsicosocial y se reivindican los roles propios. Se plantea la confusión existente en cuanto al papel de la psicoterapia y su llamativa carencia en los servicios de salud. Conclusiones: Los distintos profesionales que intervienen en el tratamiento de las personas con depresión presentan visiones particulares que es importante identificar y discutir para conseguir una atención integrada y orientada al paciente (AU)

Objectives: To know experiences and perspectives of psychologists, social workers and nurses about their role in the care of depressed patients. Method: Qualitative research with exploratory design and generation of information by means of two discussion groups. Recordings obtained after confidentiality agreement. Thematic analyses and comparison with the findings obtained in a previous study with family physicians and psychiatrists. Triangulation among researchers. Results: The main shared experiences are reciprocal lack of awareness, lack of coordination, fuzziness of the diagnosis, and risk of pathologizing problems of daily living. The non-medical professionals highlight the importance of biopsychosocial factors, while at the same time stressing the need for their own role. There is evidence of confusion regarding the role of psychotherapy and its remarkable absence in health centers. Conclusions: The different professionals that participate in the treatment of people with depression have specific visions that need to be identified and discussed in order to reach an integrated level of care. The collaboration must focus on the patient and engage the different professionals throughout the long care process (AU)

Perspectivas de los pacientes diagnosticados de depresión y atendidos por médicos de familia y psiquiatras / Views of patients diagnosed with depression and cared for by general practitioners and psychiatrists

Objetivo: Conocer las vivencias de los pacientes en tratamiento por depresión según sean atendidos por médicos de familia (MF) o por psiquiatras (PSQ), para identificar vías de mejora. Diseño: Metodología cualitativa orientada a la investigación de servicios de salud. Diseño exploratorio. Participantes y contextos: 31 pacientes diagnosticados de depresión y en tratamiento farmacológico durante al menos un año, procedentes de 20 centros de salud y 8 de salud mental del Servicio Vasco de Salud-Osakidetza en Bizkaia, agrupados según profesional (MF/PSQ) y nivel socioeconómico. Método: Generación de información mediante 5 grupos de discusión y 2 entrevistas en profundidad realizadas en 2009 y 2010. Grabación y transcripción, previo compromiso de confidencialidad y consentimiento informado. Análisis sociológico de los discursos. Triangulación de técnicas y contraste entre los investigadores. Resultados: Los pacientes presentan vivencias de la depresión vinculadas a los contextos sociales de procedencia y a los recorridos previos fuera y dentro de los servicios de salud. Dichos componentes están asimismo presentes en las percepciones sobre la calidad de la atención, con expectativas diferenciadas respecto de MF y PSQ. En general, se constatan carencias de tiempo y de psicoterapia. La colaboración entre ambos profesionales no surge espontáneamente como prioridad de los pacientes. Conclusiones: Las valoraciones de los pacientes aportan dimensiones propias sobre los componentes individual y contextual en el diagnóstico y tratamiento de la depresión. Dichas dimensiones deberían ser tenidas en cuenta en la identificación de necesidades y en el diseño de estrategias compartidas por MF y PSQ para la mejora de su asistencia(AU)

Objectives: To explore the experiences of patients treated for depression either by general practitioners (GPs) or psychiatrists (Ps) with the aim of identifying improvement strategies. Design: Health services research-oriented qualitative methodology. Exploratory design. Participants and contexts: A total of 31 patients diagnosed with depression receiving pharmacological treatment for at least one year, belonging to 20 Health Centres and 8 Mental Health Centres of the Basque Health Service-Osakidetza in Bizkaia, and grouped according to the type of professional (GPs/Ps) and socioeconomic level. Method: Information generation by means of 5 discussion groups and 2 in-depth interviews carried out in 2009 and 2010. Recording and transcription with previous confidentiality agreement and informed consent. Sociological discourse analysis. Technique triangulation and agreement among researchers. Results: Patients’ experiences of depression are associated with their social contexts and their previous experience outside and inside the health services. These components also appear in perceptions on quality of care, with different expectations related to GPs and Ps. Deficiencies in time and psychotherapy are mentioned in general. Collaboration between both professionals does not spontaneously emerge as a patient priority. Conclusions: Patient assessments provide dimensions of individual and contextual components in the diagnosis and treatment of depression. These dimensions should be taken into account in the identification of needs and the design of strategies shared by GPs and Psychiatrists to improve care(AU)

[Views of patients diagnosed with depression and cared for by general practitioners and psychiatrists]. / Perspectivas de los pacientes diagnosticados de depresión y atendidos por médicos de familia y psiquiatras.

OBJECTIVES: To explore the experiences of patients treated for depression either by general practitioners (GPs) or psychiatrists (Ps) with the aim of identifying improvement strategies. DESIGN: Health services research-oriented qualitative methodology. Exploratory design. PARTICIPANTS AND CONTEXTS: A total of 31 patients diagnosed with depression receiving pharmacological treatment for at least one year, belonging to 20 Health Centres and 8 Mental Health Centres of the Basque Health Service-Osakidetza in Bizkaia, and grouped according to the type of professional (GPs/Ps) and socioeconomic level. METHOD: Information generation by means of 5 discussion groups and 2 in-depth interviews carried out in 2009 and 2010. Recording and transcription with previous confidentiality agreement and informed consent. Sociological discourse analysis. Technique triangulation and agreement among researchers. RESULTS: Patients' experiences of depression are associated with their social contexts and their previous experience outside and inside the health services. These components also appear in perceptions on quality of care, with different expectations related to GPs and Ps. Deficiencies in time and psychotherapy are mentioned in general. Collaboration between both professionals does not spontaneously emerge as a patient priority. CONCLUSIONS: Patient assessments provide dimensions of individual and contextual components in the diagnosis and treatment of depression. These dimensions should be taken into account in the identification of needs and the design of strategies shared by GPs and Psychiatrists to improve care.

[Family doctors and psychiatrists and the patient with depression: the need to re-adjust health care approaches and organisational dynamics]. / Médicos de familia y psiquiatras ante el paciente con depresión: la necesidad de readecuar enfoques asistenciales y dinámicas organizativas.

OBJECTIVES: To find out the perceptions of family doctors (FD) and psychiatrists (PS) on their inter-relationships in the health care of patients with depression. DESIGN: Qualitative methodology. Exploratory design based on FD and PS discussion groups (DG). SETTING: Primary health care centres (PHCC) and mental health centres (MHC) of the Basque Country Health Service in Vizcaya. PARTICIPANTS AND CONTEXT: A total of 29 FD from 20 PHCC, and 13 PS from 11 MHC, distributed according to the socioeconomic level of the reference population. The meetings were arranged and held in the PC research unit. METHODS: An intentional sample to configure 4 DG of FD and 2 of PS, homogenous as regards socioeconomic level, and heterogeneous as regards the centres they came from, work experience and gender. The meetings were recorded and transcribed and a sociological discourse analysis was made. Triangulation between researchers and results comparison with the participants was carried out. RESULTS: The perceptions and attitudes of the FD and PS differed, in their connections with the patient, expectations and health care context. In both cases they perceived the unsuitability of the real patient as regards the prefixed perceptions of the professional. The increase of the problem and its management seemed to be conditioned by a social medium which was uncontrolled, and due to increasing deficiencies in the collaboration between health care levels. CONCLUSIONS: Care of the patient with depression requires diagnostic and treatment approaches centred on the patient and shared by FD and PS.

Médicos de familia y psiquiatras ante el paciente con depresión: la necesidad de readecuar enfoques asistenciales y dinámicas organizativas / Family Doctors and Psychiatrists and the Patient With Depression: the Need to Re-adjust Health Care Approaches and Organisational Dynamics

Objetivos: conocer las percepciones de los médicos de familia (MF) y psiquiatras (PS) acerca de su interrelación en la asistencia a los pacientes con depresión. Diseño: metodología cualitativa. Diseño exploratorio basado en grupos de discusión (GD) de MF y PS. Emplazamiento: centros de salud (CS) de atención primaria (AP) y centros de salud mental (CSM) del Servicio Vasco de Salud-Osakidetza en Bizkaia. Participantes y contextos: un total de 29 MF de 20 CS y 13 PS procedentes de 11 CSM, distribuidos según el nivel socioeconómico de las poblaciones de referencia. La convocatoria y las reuniones se realizaron en la unidad de investigación de AP. Método: muestreo intencional para configurar 4 GD de MF y 2 de PS, homogéneos respecto al nivel socioeconómico, y heterogéneos en cuanto a centros de procedencia, experiencia laboral y sexo. Grabación y transcripción de las reuniones. Análisis sociológico del discurso. Triangulación entre investigadores y contraste de resultados con los participantes. Resultados: las percepciones y actitudes de MF y PS difieren en su vinculación con el paciente, expectativas y contexto asistencial. En ambos casos se percibe inadecuación del paciente real respecto de los esquemas prefijados por el profesional. El aumento del problema y su manejo aparecen condicionados por un medio social que no se controla, y por deficiencias crecientes en la colaboración entre niveles asistenciales. Conclusiones: la atención al paciente con depresión requiere de enfoques diagnósticos y tratamientos centrados en el paciente y compartidos por MF y PS(AU)

Objectives: To find out the perceptions of family doctors (FD) and psychiatrists (PS) on their inter-relationships in the health care of patients with depression. Design: Qualitative methodology. Exploratory design based on FD and PS discussion groups (DG). Setting: Primary health care centres (PHCC) and mental health centres (MHC) of the Basque Country Health Service in Vizcaya. Participants and context: A total of 29 FD from 20 PHCC, and 13 PS from 11 MHC, distributed according to the socioeconomic level of the reference population. The meetings were arranged and held in the PC research unit. Methods: An intentional sample to configure 4 DG of FD and 2 of PS, homogenous as regards socioeconomic level, and heterogeneous as regards the centres they came from, work experience and gender. The meetings were recorded and transcribed and a sociological discourse analysis was made. Triangulation between researchers and results comparison with the participants was carried out. Results: The perceptions and attitudes of the FD and PS differed, in their connections with the patient, expectations and health care context. In both cases they perceived the unsuitability of the real patient as regards the prefixed perceptions of the professional. The increase of the problem and its management seemed to be conditioned by a social medium which was uncontrolled, and due to increasing deficiencies in the collaboration between health care levels. Conclusions: Care of the patient with depression requires diagnostic and treatment approaches centred on the patient and shared by FD and PS(AU)