Internações e Reinternações por Transtornos Mentais e do Comportamento pelo Sistema Único de Saúde no Brasil de 2000 a 2014

Abstract

Objectives: Two studies were conducted with the objectives of: 1) characterizing the profile of patients who were hospitalized for mental and behavioral disorders by the Unified Health System, from 2000 to 2014, and verifying how aspects of mental health policy influenced the rate of patients hospitalized in the period, and 2) to characterize the profile of patients who were readmitted for mental and behavioral disorders by the Unified Health System, from 2001 to 2014, and the factors associated with early readmission (30 days) and frequent readmission (≥3 admissions in one year). Methods: Non-concurrent retrospective cohort study using secondary data from inpatients with a primary diagnosis of mental and behavioral disorders. In the first study, patients admitted between 01/01/2000 and 12/31/2014 were considered. In the second article, patients hospitalized between 01/01/2001 and 12/31/2013 were selected, who were followed for at least one year. Sociodemographic, clinical and hospital characteristics variables were selected. In the first study, the general rates of hospitalized patients were calculated, according to the cause of hospitalization, type of hospital, legal nature and the number of hospitalizations of each patient per year. The association between hospitalized patient rates and the number of psychiatric beds per year and the number of Psychosocial Care Centers (CAPS) per year was tested. In the second study, Poisson regression models with a robust variance estimator were used to estimate the incidence rate ratios (IRR) for each of the outcomes. Results: In the first study, 1,549,298 patients were selected. The most frequent causes of hospitalization were disorders due to the use of psychoactive substances, followed by schizophrenia, schizotypal disorders and delusional disorders. The overall rate of hospitalized patients showed a downward trend of 49.9% over the period. The number of beds per year was positively associated with inpatient rates, and the number of CAPS per year was negatively associated with some inpatient rates. In the second study, it was verified that 6.8% of the selected patients had early readmission. Characteristics such as being male, younger, diagnosed with bipolar disorders and hospitalized in specialized hospitals showed higher rates of incidence of early readmission. The occurrence of frequent readmissions was verified for 8.3% of the patients, highlighting that the occurrence of early readmissions was the characteristic most strongly associated with the increase in the incidence rate of frequent readmissions, and the magnitude of this increase depends on the patient's age group. Conclusions: There was a large reduction in the rates of hospitalized patients in the period, associated with the changes made within the scope of the National Mental Health Policy, with the simultaneous reduction of psychiatric beds accompanied by the creation of new Psychosocial Care Centers. Early readmission and frequent readmission were associated with sociodemographic and clinical characteristics of individuals and organizational aspects of the health system. Due to the magnitude of the association with frequent readmissions, the occurrence of early readmissions should be considered a priority in the elaboration of therapeutic plans with a view to preventing or reducing frequent readmissions.