Social factors associated with mental disorders with risk
               situations in the primary health care

Drummond, Bruno Lopes da Costa; Radicchi, Antônio Leite Alves; Gontijo, Eliane Costa Dias

doi:10.1590/1809-4503201400060006

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Original Articles • Rev. bras. epidemiol. 17 (Suppl 2) • 2014 • https://doi.org/10.1590/1809-4503201400060006 copy

Social factors associated with mental disorders with risk situations in the primary health care

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE:

To evaluate patients with mental disorders, with or without risk situations, treated at primary health care (PHC) units.

METHOD:

A cross-sectional study was performed in samples of 240 patients living in a region of high social vulnerability in Belo Horizonte. The response variable was mental disorders with risk situations (MD-WR). The explanatory variables were gender, age, marital status, literacy, education, employment, social benefits and per capita income. Instruments from Berkman and Syme (social network), Sherbourne and Stewart (social support), adapted for Brazil, were applied. Pearson's χ² test and binary logistic regression were used for the adjusted analyzes.

RESULTS:

The factors associated with MD-WR were being male (OR = 3.62; 95%CI 1.84 - 7.09); having "up to one confident relative" only (OR = 2.53; 95%CI 1.18 - 5.42); being "not able to return home" when away from their living area (OR = 3.49; 95%CI 1.40 - 8.71). The reduction in the affective dimension of the Medical Outcomes Study (MOS) scale increases the chance of MD-WR.

Conclusion:

The availability and access to social and support networks are lower for patients with MD-WR and need to be strengthened to promote autonomy and citizenship among its users. We conclude that there is the need of public policies to increase the availability of social networking equipment and social support projects, encouraging the participation of families.

Social networking; Social support; Mental disorders; Primary health care; Life conditions; Social Determinants of Health

Variable	MD-NR	MD-WR	p-value	OR [95%CI]
Variable	n (%)	n (%)	p-value	OR [95%CI]
Gender
Male	25 (16.7)	29 (36.7)	0.001*	2.90 [1.55 – 5.43]
Female	125 (83.3)	50 (63.3)		1.00
Literacy
Can read, write and do math	84 (63.2)	34 (45.3)	0.013*	1.00
Can do one or two of the above skills	49 (36.8)	41 (54.7)		2.07 [1.16 – 3.67]
Social benefits
None	51 (37.2)	33 (44.6)	0.297*	0.74 [0.41 – 1.31]
Disability retirement	14 (10.7)	15 (20.8)	0.018*	2.27 [1.03 – 4.99]

Variable	MD-NR	MD-WR	p-value	OR [95%CI]
Variable	n (%)	n (%)	p-value	OR [95%CI]
Relationship with alcohol and tobacco
Smokes or has smoked	61 (40.7)	41 (51.9)	0.104*	1.57 [0.91 – 2.72]
Uses or has used alcohol	44 (29.5)	33 (41.8)	0.063*	1.71 [0.97 – 3.02]
Is able to go where needed when leaves the neighborhood
Yes	128 (85.9)	60 (75.9)	0.060*	1.00
No	21 (14.1)	19 (24.1)		1.93 [0.97 – 3.86]
Is able to go back home when leaves the neighborhood
Yes	139 (92.7)	65 (82.3)	0.017*	1.00
No	11 (7.3)	14 (17.7)		2.72 [1.17 – 6.32]

Variable	MD-NR		MD-WR		p-value
Dimensions*	Mean	Median	Mean	Median	p-value
1^st – affective	84.1	93.3	78.2	80.0	0.024**
2^nd – emotional	67.6	65.0	67.7	65.0	0.940**
3^rd – information	72.4	75.0	68.7	65.0	0.103**
4^th – positive social interaction	58.0	55.0	54.1	50.0	0.244**
5^th – material	79.3	85.0	79.9	85.0	0.612**
Affective + positive social interaction	69.2	65.7	64.4	62.9	0.066**
Emotional + information	70.0	67.5	68.2	67.5	0.421**

Variable	p-value	OR	95%CI
Gender
Female (reference)	< 0.001	1.00
Male		3.62	[1.84 – 7.09]
Leaves the neighborhood and is able to go back home
Yes (reference)		1.00
No	0.007	3.49	[1.40 – 8.71]
Confidant relatives
Up to one	0.017	2.53	[1.18 –; 5.42]
Two	0.259	1.69	[0.68 – 4.23]
Three or more (reference)		1.00
Affective dimension (reduction of one unit in the score)	0.042	1.015	[1.001 – 1.030]

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E-mail: revbrepi@usp.br

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[1] Corresponding author: Bruno Lopes da Costa Drummond. Municipal Health of Belo Horizonte. Rua Domingos Vieira, 273, sala 905, Santa Efigênia, CEP: 30150-240, Belo Horizonte, MG, Brasil. E-mail: brunolcdru@gmail.com