Banca de DEFESA: THIAGO BORGES ARCANJO

Uma banca de DEFESA de MESTRADO foi cadastrada pelo programa.
STUDENT : THIAGO BORGES ARCANJO
DATE: 14/12/2023
TIME: 19:30
LOCAL: Sala do aplicativo Zoom
TITLE:

Assessment of the impact of psychosocial care centers (CAPS) on psychiatric hospitalizations in Brazil from 2008 to 2019.

KEY WORDS:

Mental disorders. CAPS. Psychiatric hospitalizations

PAGES: 67
BIG AREA: Ciências da Saúde
AREA: Saúde Coletiva
SUMMARY:

It is considered that approximately 50% of adults suffer from some mental and behavioral disorder at some point in their lives. More than half of these people experience moderate to severe symptoms. It is estimated that four of the ten main causes of disability in people five years of age or older are due to mental health disorders, with depression being the main cause of all diseases that cause disability. The triggering of a mental disorder is multifactorial and constitutes events and characteristics that act as predictors of emotional, physical and social problems throughout the life cycle, such as lack of family support, low socioeconomic status, experiences of victimization, etc., also including factors such as stress, genetics, nutrition, perinatal infections and exposure to environmental hazards. Unfortunately, the resources used in mental health care are still insufficient for all individuals with some type of mental disorder to have access to treatment, especially in low-income countries. In recent decades, in Brazil, Mental Health services have undergone some transformations over time, such as the creation of RAPS – Psychosocial Care Network, with CAPS (Psychosocial Care Center) and its different modalities, the units care strategies within RAPS, aiming at actions that aim to interact with the patient, rehabilitating them for social life, reintegrating them into the environment, providing adequate treatment. Currently Brazil

has 2,755 CAPS units enabled, and between 2019 and 2021. The purpose of this research was to analyze the effect of Psychosocial Care Centers (CAPS) on hospitalizations for mental disorders in the country, motivating new studies and the improvement of policies public resources aimed at mental health. A longitudinal ecological study was carried out, using Brazilian municipalities as the unit of analysis, in the period 2008-2019. Data from 1,634 municipalities were considered, given the availability of data on psychiatric hospitalizations during this period. The period of the COVID-19 pandemic was excluded, due to the possible impact of this period on mental health. There were 3,889,568 hospital admissions due to psychiatric causes in Brazil between 2008 and 2019 in 1634 municipalities, with more than 40% due to disorders related to SCHIZOPHRENIA, followed by causes related to ALCOOL abuse. Male patients of white or mixed race/color make up the preponderant profile of those hospitalized throughout the data series in Brazil. Among Brazilian regions, the Southeast concentrated the majority of hospitalizations (52.53%), followed by the South (23.30%), Northeast (17.03%), Central-West (5.65%) and North (1 .49%). The south and northeast regions stood out for having average CAPS coverage higher than the values estimated in the present study for Brazil. In general, most municipalities in the present study presented, on average, CAPS coverage lower than 2.5 CAPS per 100 thousand inhabitants throughout the data panel considered (Figure 4). The Southeast region led in the number of hospitalizations for SCHIZOPHRENIA, ALCOHOLIC and PSYCHOACTIVES, totaling 1,344,104 hospitalizations, while the South had the highest hospitalization rates for HUMOR, with 207,615 

hospitalizations. Considering the general hospitalization model for Brazil, a positive association was detected between hospitalization rates per 100 thousand inhabita mais internações. Por fim, analisando a parte binomial dos modelos por tipo de diagnóstico é perceptível que a relação da cobertura de CAPS com a probabilidade de taxas de internação igual a zero é semelhante ao observado no modelo geral para o Brasil, i.e., a probabilidade de um município não experimentar internações pelas quatro principais categorias de diagnósticos psiquiátricos reduz 15% em média para cada incremento de cobertura de CAPS. Uma exceção foi a região norte que mostrou que cada incremento da cobertura de CAPS foi associado com um aumento da probabilidade do município não experimentar internações nos quatros modelos por diagnóstico (Figura 5). O mesmo ocorreu para internações por ALCOOL na região sudeste. Em contrapartida, na Região Centro Oeste, para a cobertura de CAPS no modelo para HUMOR, observa-se que cada incremento de uma unidade está associado com um declínio de 14% (i.e. 0,86 – 1  100) nas taxas de internações dos municípios dessa região. Mesmo com a baixa cobertura de CAPS nos municípios brasileiros, regiões com as melhores coberturas entre os municípios, i.e. sul e nordeste (veja Tabela 3), apresentaram redução nas taxas de internação por HUMOR e ESQUIZOFRENIA a cada incremento de cobertura desses centros. Isso pode sinalizar que: a) CAPS são mais efetivos em reduzir internações dessas duas causas e b) há uma efetividade reduzida para a maioria das demais causas psiquiátricas. Assim: há uma necessidade de melhorar os serviços prestados pelos CAPS ou, o que pode estar acontecendo para os CAPS não afetarem significativamente outras causas, como ALCOOL e PSICOATIVAS. Há uma variação na análise quanto à implantação do CAPS e internações dependendo da região e o diagnóstico, o que pode estar relacionado também aos fatores de riscos e de proteção, citados neste trabalho, bem como uma baixa cobertura do CAPS em muitas regiões. Esse estudo evidenciou que o aumento da cobertura do CAPS esteve associado ao aumento das hospitalizações por transtornos psiquiátricos, mas com importante decréscimo das hospitalizações quando os municípios apresentam maiores coberturas sustentadas ao longo do tempo. Assim, novos estudos são indispensáveis para se buscar análises distintas, como gestão da rede, análise sobre a efetividade do CAPS através do matriciamento, acolhimento do usuário e família, adesão ao tratamento, qualificação profissional, entre outros aspectos. nts and CAPS coverage, i.e., each increase in CAPS coverage in the municipalities was related to 1.30 times more hospitalization rates. hospitalizations, that is, in general, considering all AIHs, a reduction in hospital admissions due to psychiatric diagnoses was not observed with the increase in CAPS coverage, a different result from previous studies carried out. It was evident that most municipalities have similar CAPS coverage, despite varying numbers of AIHs. Municipalities with low CAPS coverage (close to zero) have high numbers of hospitalizations, as well as those with the best rates. This may indicate a weak association between the two variables, although the positive effect observed in the models was significant. It is likely that increases in hospitalization rates with each increase in CAPS coverage are reflecting a characteristic of the health system or economic conditions of the municipality, given that, in general, the probability of zero hospitalizations occurring in a municipality is negatively related to the number of beds and GDP per capita. Thus, it is expected that where there are more beds available, larger populations and better economic conditions will occur

COMMITTEE MEMBERS:
Presidente - ***.845.265-** - FLÁVIA JÔSE OLIVEIRA ALVES - UFBA
Externa ao Programa - 1094589 - DÉBORAH SANTOS CONCEIÇÃO - UFBAExterno à Instituição - WASHINGTON LUIZ ABREU DE JESUS