RESUMO

BACKGROUND: The rapid growth of the size of the older population is having a substantial effect on health and social care services in many societies across the world. Maintaining health and functioning in older age is a key public health issue but few studies have examined factors associated with inequalities in trajectories of health and functioning across countries. The aim of this study was to investigate trajectories of healthy ageing in older men and women (aged ≥45 years) and the effect of education and wealth on these trajectories. METHODS: This population-based study is based on eight longitudinal cohorts from Australia, the USA, Japan, South Korea, Mexico, and Europe harmonised by the EU Ageing Trajectories of Health: Longitudinal Opportunities and Synergies (ATHLOS) consortium. We selected these studies from the repository of 17 ageing studies in the ATHLOS consortium because they reported at least three waves of collected data. We used multilevel modelling to investigate the effect of education and wealth on trajectories of healthy ageing scores, which incorporated 41 items of physical and cognitive functioning with a range between 0 (poor) and 100 (good), after adjustment for age, sex, and cohort study. FINDINGS: We used data from 141 214 participants, with a mean age of 62·9 years (SD 10·1) and an age range of 45-106 years, of whom 76 484 (54·2%) were women. The earliest year of baseline data was 1992 and the most recent last follow-up year was 2015. Education and wealth affected baseline scores of healthy ageing but had little effect on the rate of decrease in healthy ageing score thereafter. Compared with those with primary education or less, participants with tertiary education had higher baseline scores (adjusted difference in score of 10·54 points, 95% CI 10·31-10·77). The adjusted difference in healthy ageing score between lowest and highest quintiles of wealth was 8·98 points (95% CI 8·74-9·22). Among the eight cohorts, the strongest inequality gradient for both education and wealth was found in the Health Retirement Study from the USA. INTERPRETATION: The apparent difference in baseline healthy ageing scores between those with high versus low education levels and wealth suggests that cumulative disadvantage due to low education and wealth might have largely deteriorated health conditions in early life stages, leading to persistent differences throughout older age, but no further increase in ageing disparity after age 70 years. Future research should adopt a lifecourse approach to investigate mechanisms of health inequalities across education and wealth in different societies. FUNDING: European Union Horizon 2020 Research and Innovation Programme.

Assuntos

Escolaridade , Disparidades nos Níveis de Saúde , Envelhecimento Saudável , Renda/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Austrália , Estudos de Coortes , Europa (Continente) , Feminino , Humanos , Japão , Masculino , México , Pessoa de Meia-Idade , República da Coreia , Estados Unidos

RESUMO

BACKGOUND: In order to reduce the treatment gap of mental disorders, the World Health Organization (WHO) has proposed the mhGAP guidelines to be implemented globally. AIM OF THE STUDY: To examine the effectivity of a training course based on the WHO-mhGAP guidelines to increase knowledge and readiness for identification and management of depression and suicide risk in primary care (PC) in Mexico. METHODS: PC clinicians were invited to participate in a traning course; before and after it, all completed an evaluation of knowledge of mhGAP and depression (0-10 points), and self-efficacy in suicide risk management (0-40 points), and were classified according to Prochaska and Diclemente transtheorical model in their particular stage of readiness for identification and management of these conditions. RESULTS: The sample included 60 health professionals. Before training, clinicians had adequate knowledge of depression and its treatment (8.1 ± 1.66), but not on the mhGAP model and/or suicide risk management, which increased by the end of training (mhGAPpre:7.91 ± 2.19 vs. mhGAPpost:8.77 ± 1.34, p = 0.01; SuicidePRE:29.16 ± 9.35 vs. SuicidePOST:39.24 ± 6.83, p = 0.0001). Before training, most clinicians were at the contemplation stage (42.6% vs. 37.7% at the action and 19.7% at the precontemplation stage). By the end of the training, a decrease in the number of clinicians at both the contemplation and precontemplation stages (to 36.1% and to zero, respectively) and a significant increase of clinicians at the action stage (to 63.9%) was observed. CONCLUSIONS: A training course based on the WHO-mhGAP could be an effective tool for increasing PC clinicians' willingness to implement mental health services.

Assuntos

Depressão/terapia , Pessoal de Saúde/educação , Transtornos Mentais/terapia , Prevenção do Suicídio , Adulto , Educação Médica Continuada/métodos , Feminino , Humanos , Masculino , Serviços de Saúde Mental , México , Pessoa de Meia-Idade , Atenção Primária à Saúde , Organização Mundial da Saúde

RESUMO

Latin American and the Caribbean countries exhibit high life expectancy and projections show that they will experience the fastest growth of older people in the following years. As people live longer, it is important to maximise the opportunity to age healthily. We aimed to examine the associations of lifestyle behaviours with healthy ageing in Cuba, Dominican Republic, Peru, Mexico and Puerto Rico, part of the 10/66 study. Residents 65 years old and over (n = 10,900) were interviewed between 2003 and 2010. In the baseline survey, we measured four healthy behaviours: Physical activity, non-smoking, moderate drinking and fruits or vegetables consumption. Healthy ageing was conceptualised within the functional ability framework over a median of 4 years follow-up. Logistic models were calculated per country and then pooled together with fixed-effects meta-analysis. People engaging in physical activity and consuming fruits or vegetables had increased odds of healthy ageing in the follow-up (OR: 2.59, 95% CI: 2.20⁻3.03; OR: 1.24, 95% CI: 1.06⁻1.44, respectively). Compared with participants engaging in none or one healthy behaviour, the ORs of participants engaging in two, three or four healthy behaviours increased in a linear way (OR: 1.60, 95% CI: 1.40⁻1.84; OR: 2.29, 95% CI: 1.94⁻2.69; OR: 2.46, 95% CI: 1.54⁻3.92, respectively). Our findings highlight the importance of awareness of a healthy lifestyle behaviour among older people.

Assuntos

Comportamentos Relacionados com a Saúde , Envelhecimento Saudável , Estilo de Vida Saudável , Expectativa de Vida , Idoso , Idoso de 80 Anos ou mais , Consumo de Bebidas Alcoólicas , Região do Caribe , Área Programática de Saúde , Estudos de Coortes , Cuba , República Dominicana , Exercício Físico , Feminino , Frutas , Humanos , Modelos Logísticos , Masculino , México , Pessoa de Meia-Idade , Peru , Porto Rico , Verduras

RESUMO

OBJECTIVES: The objective of this study was to identify which environmental factors are the most responsible for the disability experienced by persons with mental disorders and whether they differ (1) from those in cardiovascular diseases, chronic respiratory conditions, diabetes, and cancer, and (2) depending on the capacity level-a proxy for the impact of health conditions on the health state of individuals. METHODS: Nationally representative data from 12,265 adults in Chile collected in 2015 with the WHO Model Disability Survey was analyzed. RESULTS: The availability of personal assistance, frequency of receiving personal assistance, and assistive devices for mobility were the most important environmental factors across mental and other non-communicable diseases. Perception of discrimination and use of health services were also prominent factors. There was a huge overlap between the factors found relevant for mental and other non-communicable diseases, but a substantial variability depending on the intensity of difficulties in capacity. CONCLUSIONS: This study challenges the appropriateness of disease-specific approaches and suggests that considering intrinsic capacity levels is more informative than focusing on diagnosis alone when comparing needs and barriers that affect the performance in daily life of specific groups of individuals.

Assuntos

Pessoas com Deficiência/psicologia , Saúde Ambiental , Transtornos Mentais/epidemiologia , Atividades Cotidianas , Adulto , Chile/epidemiologia , Pessoas com Deficiência/estatística & dados numéricos , Feminino , Acessibilidade aos Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Doenças não Transmissíveis/epidemiologia , Inquéritos e Questionários

RESUMO

BACKGROUND: Unhealthy lifestyles and depression are highly interrelated: depression might elicit and exacerbate unhealthy lifestyles and people with unhealthy lifestyles are more likely to become depressed over time. However, few longitudinal evidence of these relationships has been collected in emerging countries. The present study aims i) to analyse whether people with unhealthy lifestyles are more likely to develop depression, and ii) to examine whether depressed people with unhealthy lifestyles are more likely to remain depressed. A total of 7908 participants from Ghana, India, Mexico and Russia were firstly evaluated in the World Health Organization's Study on Global AGEing and Adult Health (SAGE) Wave 0 (2002-2004) and re-evaluated in 2007-2010 (Wave 1). Data on tobacco use, alcohol drinking and physical activity, were collected. Logistic regressions models were employed to assess whether baseline unhealthy lifestyles were related to depression in Wave 1, among people without 12-month depression in Wave 0 and any previous lifetime diagnosis of depression, and to 12-month depression at both study waves (persistent depression). RESULTS: Baseline daily and non-daily smoking was associated with depression in Wave 1. Low physical activity and heavy alcohol drinking were associated with persistent depression. CONCLUSIONS: Unhealthy lifestyles and depression are also positively related in emerging countries. Smoking on a daily and non-daily basis was longitudinally related to depression. Depressed people with low physical activity and with heavy drinking patterns were more likely to become depressed over time. Several interpretations of these results are given. Further studies should check whether a reduction of these unhealthy lifestyles leads to lower depression rates and/or to a better clinical prognosis of depressed people.

Assuntos

Depressão/etiologia , Incidência , Estilo de Vida/etnologia , Adulto , Idoso , Alcoolismo/epidemiologia , Alcoolismo/psicologia , Fumar Cigarros/epidemiologia , Fumar Cigarros/psicologia , Depressão/epidemiologia , Depressão/psicologia , Exercício Físico/psicologia , Feminino , Gana/epidemiologia , Gana/etnologia , Humanos , Índia/epidemiologia , Índia/etnologia , Estudos Longitudinais , Masculino , México/epidemiologia , México/etnologia , Pessoa de Meia-Idade , Federação Russa/epidemiologia , Federação Russa/etnologia , Organização Mundial da Saúde/organização & administração

RESUMO

OBJECTIVE: The aim of this study was to evaluate the factors associated with different components of arterial blood pressure in nine nationally-representative samples of people aged ≥50 years. METHODS: Data were available for 53,289 people aged ≥18 years who participated in the SAGE (WHO Study on global AGEing and adult health) study conducted in China, Ghana, India, Mexico, Russia, and South Africa, and the COURAGE (Collaborative Research on Ageing in Europe) study conducted in Finland, Poland, and Spain, between 2007 and 2012. Standard procedures were used to obtain diastolic and systolic blood pressure (DBP, SBP) measurements to identify hypertensive participants, and to determine mean arterial blood pressure (MAP) and pulse pressure (PP). RESULTS: The analytical sample consisted of 42,116 people aged 50 years or older. South Africa had the highest prevalence of hypertension (78.3%), and the highest measurements of MAP ± SD (113.6 ± 36.4 mmHg), SBP ± SD (146.4 ± 49.5 mmHg), and DBP ± SD (97.2 ± 33.9 mmHg). In the adjusted models, dose-dependent positive associations between Body Mass Index (BMI) and MAP or PP were observed in most countries (p < 0.05). Diabetes was positively associated with PP in most countries but the association between diabetes and MAP was less consistent. Stroke was associated with both higher MAP and PP in China, Ghana, and South Africa (p < 0.05). CONCLUSIONS: Obesity and diabetes remain important modifiable risk factors for arterial peripheral resistance and stiffness as reflected by MAP and PP respectively. Controlling arterial pressure abnormalities after stroke events may be important for secondary prevention, particularly in developing countries.

Assuntos

Antropometria , Pressão Arterial , Hipertensão/epidemiologia , Adulto , África/epidemiologia , Fatores Etários , Idoso , Ásia/epidemiologia , Índice de Massa Corporal , Comorbidade , Estudos Transversais , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Europa (Continente)/epidemiologia , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Obesidade/diagnóstico , Obesidade/epidemiologia , Prevalência , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Fatores de Tempo , Resistência Vascular , Rigidez Vascular

RESUMO

OBJECTIVE: To explore the rationales of mental health professionals (mainly psychiatrists and psychologists) from 8 countries for removing specific diagnostic categories from mental disorders classification systems. METHOD: As part of a larger study, 505 participants indicated which of 60 major disorders should be omitted from mental disorders classification systems and provided rationales. Rationale statements were analyzed using inductive content analysis. RESULTS: The majority of clinicians (60.4%) indicated that 1 or more disorders should be removed. The most common rationales were (a) problematic boundaries between normal and psychopathological conditions (45.9% of total removal recommendations), (b) problematic boundaries among mental disorders (25.4%), and (c) problematic boundaries between mental and physical disorders (24.0%). The categories most frequently recommended for deletion were gender identity disorder, sexual dysfunction, and paraphilias, usually because clinicians viewed these categories as being based on stigmatization of a way of being and behaving. A range of neurocognitive disorders were described as better conceptualized as nonpsychiatric medical conditions. Results were analyzed by country and country income level. Although gender identity disorder was the category most frequently recommended for removal overall, clinicians from Spain, India, and Mexico were most likely to do so and clinicians from Nigeria and Japan least likely, probably because of social and systemic factors that vary by country. Systematic differences in removal rationales by country income level may be related to the development, structure, and functioning of health systems. CONCLUSION: Implications for development and dissemination of the classification of mental and behavioral disorders in WHO's ICD-11 are discussed.

Assuntos

Atitude do Pessoal de Saúde , Manual Diagnóstico e Estatístico de Transtornos Mentais , Pessoal de Saúde/psicologia , Classificação Internacional de Doenças , Transtornos Mentais/classificação , Transtornos Mentais/psicologia , Brasil , China , Países em Desenvolvimento/economia , Identidade de Gênero , Humanos , Índia , Japão , México , Nigéria , Psiquiatria , Psicologia , Espanha , Estereotipagem , Estados Unidos , Organização Mundial da Saúde

RESUMO

BACKGROUND: Data on the association between chronic conditions or the number of chronic conditions and sleep problems in low- or middle-income countries is scarce, and global comparisons of these associations with high-income countries have not been conducted. METHODS: Data on 42116 individuals 50 years and older from nationally-representative samples of the Collaborative Research on Ageing in Europe (Finland, Poland, Spain) and the World Health Organization's Study on Global Ageing and Adult Health (China, Ghana, India, Mexico, Russia, South Africa) conducted between 2011-2012 and 2007-2010 respectively were analyzed. RESULTS: The association between nine chronic conditions (angina, arthritis, asthma, chronic lung disease, depression, diabetes, hypertension, obesity, and stroke) and self-reported severe/extreme sleep problems in the past 30 days was estimated by logistic regression with multiple variables. The age-adjusted prevalence of sleep problems ranged from 2.8% (China) to 17.0% (Poland). After adjustment for confounders, angina (OR 1.75-2.78), arthritis (OR 1.39-2.46), and depression (OR 1.75-5.12) were significantly associated with sleep problems in the majority or all of the countries. Sleep problems were also significantly associated with: asthma in Finland, Spain, and India; chronic lung disease in Poland, Spain, Ghana, and South Africa; diabetes in India; and stroke in China, Ghana, and India. A linear dose-dependent relationship between the number of chronic conditions and sleep problems was observed in all countries. Compared to no chronic conditions, the OR (95%CI) for 1,2,3, and ≥ 4 chronic conditions was 1.41 (1.09-1.82), 2.55 (1.99-3.27), 3.22 (2.52-4.11), and 7.62 (5.88-9.87) respectively in the overall sample. CONCLUSIONS: Identifying co-existing sleep problems among patients with chronic conditions and treating them simultaneously may lead to better treatment outcome. Clinicians should be aware of the high risk for sleep problems among patients with multimorbidity. Future studies are needed to elucidate the best treatment options for comorbid sleep problems especially in developing country settings.

Assuntos

Transtornos do Sono-Vigília/epidemiologia , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Doença Crônica/epidemiologia , Comorbidade , Europa (Continente) , Feminino , Gana/epidemiologia , Humanos , Índia/epidemiologia , Modelos Logísticos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Fatores de Risco , Federação Russa/epidemiologia , África do Sul/epidemiologia

RESUMO

BACKGROUND: The Day Reconstruction Method (DRM) was developed to assess affective states as measures of experienced well-being. The present study aimed to validate an abbreviated version of the DRM in a representative sample of the population in seven countries (China, Ghana, India, Mexico, Russia, South Africa, and Spain), and to examine whether there are country differences in affect and in the relationships among the activities based on the similarity of the affect associated with each of them. METHODS: Interviews were conducted with 47,222 non-institutionalized adults from seven countries, using an abbreviated version of the DRM. A cluster analysis was carried out to classify activities on the basis of the similarity of the associated affect. In each country, the factorial structure of the affect adjectives was tested through Confirmatory Factor Analysis. Internal consistency and construct validity were also assessed. Moreover, the differences in affect across countries and the diurnal cycles of affect were evaluated. RESULTS: The DRM showed adequate psychometric properties regarding reliability and construct validity in all countries. Respondents from Ghana and South Africa reported more positive net affect whereas Indian respondents reported less positive net affect. Most of the countries showed a similar diurnal variation of affect, which tended to improve throughout the day. CONCLUSIONS: The results show that this abbreviated version of the DRM is a useful tool for multi-country evaluation of experienced well-being.

Assuntos

Atividades Cotidianas/psicologia , Psicometria/normas , Idoso , China , Escolaridade , Análise Fatorial , Feminino , Gana , Humanos , Índia , Masculino , México , Pessoa de Meia-Idade , Satisfação Pessoal , Psicometria/estatística & dados numéricos , Reprodutibilidade dos Testes , Federação Russa , África do Sul , Espanha , Inquéritos e Questionários

RESUMO

OBJECTIVE: To identify the cross-national prevalence of psychotic symptoms in the general population and to analyze their impact on health status. METHOD: The sample was composed of 256,445 subjects (55.9% women), from nationally representative samples of 52 countries worldwide participating in the World Health Organization's World Health Survey. Standardized and weighted prevalence of psychotic symptoms were calculated in addition to the impact on health status as assessed by functioning in multiple domains. RESULTS: Overall prevalences for specific symptoms ranged from 4.80% (SE = 0.14) for delusions of control to 8.37% (SE = 0.20) for delusions of reference and persecution. Prevalence figures varied greatly across countries. All symptoms of psychosis produced a significant decline in health status after controlling for potential confounders. There was a clear change in health impact between subjects not reporting any symptom and those reporting at least one symptom (effect size of 0.55). CONCLUSIONS: The prevalence of the presence of at least one psychotic symptom has a wide range worldwide varying as much as from 0.8% to 31.4%. Psychotic symptoms signal a problem of potential public health concern, independent of the presence of a full diagnosis of psychosis, as they are common and are related to a significant decrement in health status. The presence of at least one psychotic symptom is related to a significant poorer health status, with a regular linear decrement in health depending on the number of symptoms.

Assuntos

Delusões/epidemiologia , Alucinações/epidemiologia , Transtornos Psicóticos/epidemiologia , Adulto , África/epidemiologia , Ásia/epidemiologia , Comparação Transcultural , Delusões/classificação , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , América do Norte/epidemiologia , Prevalência , América do Sul/epidemiologia , Organização Mundial da Saúde

RESUMO

In the context of the updating of the International Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10), this study conducted a code-by-code comparison between the ICD-10 chapter "Mental and Behavioural Disorders" and the diagnostic categories of two Latin American classification schemes: the Third Cuban Psychiatric Glossary (GC-3) and the Latin American Guide to Psychiatric Diagnosis (GLADP). The objective was to help define what categories in the current classification should be broadened and what new categories might be added to the future ICD-11 to make it more applicable in local sociocultural and clinical contexts that differ from those found in regions whose perspectives have historically dominated the ICD, namely, the United States and Europe. It is hoped that the results will contribute to the efforts under way to develop a genuinely international classification system.

Assuntos

Classificação Internacional de Doenças , Transtornos Mentais/classificação , Cuba , Cultura , Dicionários como Assunto , Humanos , Classificação Internacional de Doenças/classificação , Idioma , América Latina , Psiquiatria , Organização Mundial da Saúde

RESUMO

Dentro del marco del análisis de la décima revisión de la Clasificación Internacional de Enfermedades y Problemas de Salud Asociados (CIE-10), se realizó una comparación código a código entre las categorías diagnósticas de dos clasificaciones latinoamericanas -el Tercer Glosario Cubano de Psiquiatría (GC-3) y la Guía Latinoamericana para el Diagnóstico Psiquiátrico (GLADP)- y el capítulo de "Trastornos mentales y del comportamiento" de la CIE-10. El objetivo fue ayudar a definir qué categorías de la clasificación actual deberían ampliarse y qué nuevas categorías podrían añadirse a la futura CIE-11 para lograr una mayor aplicabilidad local en contextos socioculturales y clínicos distintos del estadounidense y del europeo, cuyas perspectivas han dominado la CIE históricamente. Se espera que el resultado contribuya a los esfuerzos que se están llevando a cabo para desarrollar un sistema clasificatorio que sea genuinamente internacional.

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In the context of the updating of the International Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10), this study conducted a code-by-code comparison between the ICD-10 chapter "Mental and Behavioural Disorders" and the diagnostic categories of two Latin American classification schemes: the Third Cuban Psychiatric Glossary (GC-3) and the Latin American Guide to Psychiatric Diagnosis (GLADP). The objective was to help define what categories in the current classification should be broadened and what new categories might be added to the future ICD-11 to make it more applicable in local sociocultural and clinical contexts that differ from those found in regions whose perspectives have historically dominated the ICD, namely, the United States and Europe. It is hoped that the results will contribute to the efforts under way to develop a genuinely international classification system.

Assuntos

Humanos , Classificação Internacional de Doenças , Transtornos Mentais/classificação , Cuba , Cultura , Dicionários como Assunto , Classificação Internacional de Doenças/classificação , Idioma , América Latina , Psiquiatria , Organização Mundial da Saúde

Assuntos

Classificação Internacional de Doenças , Saúde Mental , Transtornos Mentais , América Latina , Classificação Internacional de Doenças , Saúde Mental , Transtornos Mentais , América Latina , Cuba , Cultura , Dicionários como Assunto , Idioma , Psiquiatria , Classificação Internacional de Doenças , Transtornos Mentais , Organização Mundial da Saúde

RESUMO

OBJECTIVE: Schizophrenia is a highly disabling disease and is costly to treat. We set out to establish what are the most cost-effective interventions applicable to developing regions and countries. METHODS: Analysis was undertaken at the level of three WHO subregions spanning the Americas, Africa and South-East Asia, and subsequently in three member states (Chile, Nigeria and Sri Lanka). A state transition model was used to estimate the population-level health impact of older and newer antipsychotic drugs, alone or in combination with psychosocial intervention. Total population-level costs (in international dollars or local currencies) and effectiveness (measured in disability-adjusted life years averted) were combined to form cost-effectiveness ratios. FINDINGS: The most cost-effective interventions were those using older antipsychotic drugs combined with psychosocial treatment, delivered via a community-based service model (I$ 2350-7158 per disability-adjusted life year averted across the three subregions, I$ 1670-3400 following country-level contextualisation within each of these subregions). The relative cost-effectiveness of interventions making use of newer, "atypical" antipsychotic drugs is estimated to be much less favourable. CONCLUSION: By moving to a community-based service model and selecting efficient treatment options, the cost of substantially increasing treatment coverage is not high (less than I$ 1 investment per capita). Taken together with other priority-setting criteria such as disease severity, vulnerability and human rights protection, this study suggests that a great deal more could be done for persons and families living under the spectre of this disorder.

Assuntos

Antipsicóticos/economia , Serviços Comunitários de Saúde Mental/economia , Países em Desenvolvimento , Custos de Cuidados de Saúde/estatística & dados numéricos , Psicoterapia/economia , Esquizofrenia/terapia , África Ocidental , Antipsicóticos/uso terapêutico , Sudeste Asiático , Análise Custo-Benefício , Humanos , Pessoas Mentalmente Doentes/estatística & dados numéricos , Modelos Econométricos , Modelos Organizacionais , Psicoterapia/estatística & dados numéricos , Informática em Saúde Pública , Anos de Vida Ajustados por Qualidade de Vida , Esquizofrenia/economia , Esquizofrenia/epidemiologia , América do Sul , Organização Mundial da Saúde

RESUMO

BACKGROUND: Numerous studies have documented high rates of functional impairment among bipolar disorder (BD) patients, even during phases of remission. However, the majority of the available instruments used to assess functioning have focused on global measures of functional recovery rather than specific domains of psychosocial functioning. In this context, the Functioning Assessment Short Test (FAST) is a brief instrument designed to assess the main functioning problems experienced by psychiatric patients, particularly bipolar patients. It comprises 24 items that assess impairment or disability in six specific areas of functioning: autonomy, occupational functioning, cognitive functioning, financial issues, interpersonal relationships and leisure time. METHODS: 101 patients with DSM-IV TR bipolar disorder and 61 healthy controls were assessed in the Bipolar Disorder Program, Hospital Clinic of Barcelona. The psychometric properties of FAST (feasibility, internal consistency, concurrent validity, discriminant validity (euthymic vs acute patients), factorial analyses, and test-retest reliability) were analysed. RESULTS: The internal consistency obtained was very high with a Cronbach's alpha of 0.909. A highly significant negative correlation with GAF was obtained (r = -0.903; p < 0.001) pointing to a reasonable degree of concurrent validity. Test-retest reliability analysis showed a strong correlation between the two measures carried out one week apart (ICC = 0.98; p < 0.001). The total FAST scores were lower in euthymic (18.55 +/- 13.19; F = 35.43; p < 0.001) patients, as compared with manic (40.44 +/- 9.15) and depressive patients (43.21 +/- 13.34). CONCLUSION: The FAST showed strong psychometrics properties and was able to detect differences between euthymic and acute BD patients. In addition, it is a short (6 minutes) simple interview-administered instrument, which is easy to apply and requires only a short period of time for its application.

RESUMO

La distinta calidad del estado de ánimo depresivo constituye un signo clínico que, recientemente, ha sido suprimido de las clasificaciones diagnósticas DSM-III-R y CIE-10. Se presenta una introducción a este concepto partiendo de su estudio en diversos textos clásicos de la literatura psiquiátrica. En conclusión, se estima desafortunada su eliminación de los criterios diagnósticos operativos utilizados en la actualidad

Assuntos

Transtorno Depressivo/diagnóstico , Transtorno Depressivo/história

RESUMO

La distinta calidad del estado de ánimo depresivo constituye un signo clínico que, recientemente, ha sido suprimido de las clasificaciones diagnósticas DSM-III-R y CIE-10. Se presenta una introducción a este concepto partiendo de su estudio en diversos textos clásicos de la literatura psiquiátrica. En conclusión, se estima desafortunada su eliminación de los criterios diagnósticos operativos utilizados en la actualidad (AU)

Assuntos

Transtorno Depressivo/diagnóstico , Transtorno Depressivo/história