RESUMO

Resumo: Os antidepressivos são a terceira classe medicamentosa mais prescrita, sendo que a maioria das prescrições não é realizada por especialistas. O objetivo do estudo é avaliar a autopercepção de confiança na prescrição de antidepressivos por médicos da atenção primária à saúde (APS). Foi realizado estudo de corte transversal de médicos atuantes na APS da cidade de Salvador, Bahia, Brasil. Foram excluídos psiquiatras ou residentes de psiquiatria. A autoavaliação da confiança, assim como a coleta de características dos participantes foi realizada por meio de questionário online. Variáveis categóricas foram descritas em termos de frequência absoluta e relativa. Variáveis contínuas foram descritas como média ou mediana, conforme distribuição de normalidade. No contexto total de 447 médicos, a amostra foi composta por 55 participantes. A média de idade foi de 37,2 (±12,8) anos. A maioria dos médicos (75%) reconheceu-se confiante na prescrição de antidepressivos. A autopercepção de confiança manteve-se predominante em cenários de pacientes idosos (69,2%) e portadores de comorbidades gerais (65,4%). A minoria mostrou confiança para prescrever antidepressivos a crianças/adolescentes (19,2%) e gestantes (26,9%). Para 80,4% dos participantes, os inibidores seletivos da recaptação de serotonina foram a classe farmacológica de maior confiança. O encaminhamento para o Centro de Atenção Psicossocial foi a estratégia mais referida em casos de insegurança na prescrição (32%). Até onde se sabe, esse é o primeiro estudo a abordar tal questão. Por essa razão, ele pode contribuir para a construção de ações de educação em saúde mais assertivas voltadas a médicos da APS.

Abstract: Antidepressants are the third most prescribed drug class, and most prescriptions are not performed by specialists. This study aimed to evaluate primary health care (PHC) physicians' self-perceived confidence in prescribing antidepressants. This is a cross-sectional study with PHC physicians in the municipality of Salvador, Bahia State, Brazil. Psychiatrists or psychiatry residents were excluded. The self-assessment of confidence and the collection of participants' characteristics was carried out by an online questionnaire. Categorical variables were presented in absolute and relative frequencies. Continuous variables were described as means or medians according to their normality distribution. Of 447 physicians, the sample consisted of 55 participants. Their mean age was 37.2 ± 12.8 years. Most physicians (75%) claimed confidence in prescribing antidepressants. Self-perceived confidence remained predominant in scenarios with older adults (69.2%) and patients with general comorbidities (65.4%). A minority showed confidence to prescribe antidepressants to children/adolescents (19.2%) and pregnant women (26.9%). For 80.4% of participants, selective serotonin reuptake inhibitors were the most trusted pharmacological class. Referral to the Psychosocial Care Center was the most reported strategy in cases of insecure prescription (32%). To the best of our knowledge, this is the first study to address such an issue. Thus, it can contribute to more assertive health education actions for PHC physicians.

Resumen: Los antidepresivos son la tercera clase de medicamentos más prescritos, y la mayoría de las prescripciones no son realizadas por especialistas. El objetivo del estudio es evaluar la autopercepción de confianza en la prescripción de antidepresivos por parte de los médicos de atención primaria de salud (APS). Corte transversal de médicos que trabajan en la APS de la ciudad de Salvador, Bahia, Brasil. Se excluyeron a los psiquiatras o residentes de psiquiatría. La autoevaluación de la confianza, así como la recolección de las características de los participantes, fue realizada a través de un cuestionario online. Las variables categóricas se describieron en términos de frecuencia absoluta y relativa. Las variables continuas se describieron como media o mediana, según la distribución de normalidad. En el contexto total de 447 médicos, la muestra estaba formada por 55 participantes. La edad promedio fue de 37,2 (±12,8) años. La mayoría de los médicos (75%) se reconocieron confiados en la prescripción de antidepresivos. La autopercepción de confianza se mantuvo predominante en los escenarios de pacientes ancianos (69,2%) y portadores de comorbilidades generales (65,4%). La minoría mostró confianza para prescribir antidepresivos a niños/adolescentes (19,2%) y mujeres embarazadas (26,9%). Para el 80,4% de los participantes, los inhibidores selectivos de la recaptación de serotonina eran la clase farmacológica de mayor confianza. El encaminamiento para el Centro de Atención Psicosocial fue la estrategia más mencionada en los casos de inseguridad en la prescripción (32%). Hasta donde se sabe, este es el primer estudio que aborda este tema. Por esa razón, puede contribuir para la construcción de acciones de educación en salud más asertivas dirigidas a los médicos de la APS.

RESUMO

INTRODUCTION: Yellow September (YS) is a Brazilian suicide prevention campaign implemented in 2015, however, its effectiveness in reducing mortality is still unknown. MATERIAL AND METHODS: This is an ecologically interrupted time series study that analyses the evolution of suicide rates in Brazil between 2011 and 2019 and its association with the implementation of YS at a national level. Data was provided by the Mortality Information System. A segmented interrupted series regression analysis was performed, using a generalized linear Poisson model, with correction for seasonal trends. RESULTS: There was an increase in the annual rates of suicide deaths between 2011 and 2019, with 4.99 and 6.41 suicides per 100,000 inhabitants, respectively. The null hypothesis, that the YS did not change the historical trend of growth in suicides in Brazil after its implementation, was affirmed. However, there was an eventual significant increase of 6.2% in the risk of mortality in 2017 and of 8.6% in 2019. DISCUSSION: The results are consistent with the literature, which proposes that campaigns focused solely on publications through the media generate unsound findings regarding the effective reduction in the number of deaths by suicide. Conclusions: The lack of initiative in multisectoral actions may explain the failure of YS on changing deaths by suicide, therefore the development of new lines of action focused on training professionals and expanding the care network could make it an effective instrument in reducing mortality from suicide. CONCLUSIONS: The lack of initiative in multisectoral actions may explain the failure of YS on changing deaths by suicide, therefore the development of new lines of action focused on training professionals and expanding the care network could make it an effective instrument in reducing mortality from suicide.