A importância dos fatores sociais em transtornosmentais graves na atenção primária de saúde.

Abstract

Introduction: Severe mental disorders, particularly those with risk situations, have a complex clinical evolution. This complexity is related to social factors in the primary health care. Social factors, mainly social network and support, play an important role in the strategy to treat severe mental disorders. Thus, it is important to know mental disorders and social factors in the primary health care. This dissertation has the purpose, in this first paper, of describing the epidemiological clinical profile of mental disorders, prioritizing the severe ones with risksituations, and the social equipments available in the referral area of four Primary Health Care Centers - PHCC. Subsequently, in a second paper, social factors, mainly social network and support, associated to severe mental disorders with risk situations. Method: First, a descriptive study of mental disorder carriers (having or not risk situations), of risk situationsin groups of severe mental disorders and of social equipment available. After the survey of 853 medical charts from four PHCCs, a descriptive statistical analysis was performed, as well as chi-square and mapping of the studied area. Then, a descriptive and comparative study was carried out between the groups which presented risk situations (severe mental disorders SMD) or not (other mental disorders OMD), regarding social factors: network, support, life style, and socio-demographic variables. Questionnaires were applied to a sample of 240 users of health mental care in the four PHCCs. Descriptive statistical analysis, as well as univariate analysis and binary logistic regression was performed. Results: Seventy-two percent of the sample was OMD, predominantly females and with anxiety disorders. On the other hand, out of the 28% of SMD, functional and organic psychoses have predominated, although with a large number of severe neurotic disorders. Risk situations with a larger proportion were: neurological comorbidity (42%) and psychiatric hospitalization (33%). Social network presents 37 social projects, distributed by 31 equipments, in seven types of activities. In thecomparative study, factors which remained associated in the binary logistic regression were: being a male, having up to one confidant relative (social network), not being able to go back home when leaving the place where they live (life conditions) and decreased affectivedimension in the scale used to measure the social support. Conclusions: The presence of SMD in primary health care is important and the fact of distinguishing them by means of risk situations, allows including severe neurotic disorders in the planning. The social network isvulnerable due to the considerable proportion of SMD regarding the scarce number of equipment and the distance between them and the users homes. In conclusion, policies are urgently needed in order to increase the number of equipments in social network and socialsupport projects with the participation of the families, particularly for SMDs with risk situations.