Abstract Background While there are reviews of the literature on mental health stigma reduction programs, very few have focused on the workplace. Objective: We sought to identify, describe and compare the main characteristics of the interventions to reduce the stigma towards mental health at work. Method The search of original articles (2007 to 2022) was carried out in the Web of Science Core Collection and Scopus databases, selecting 25 articles from the key terms: 1. Stigma, 2. Workplace, 3. Anti-stigma intervention/program, 4. Mental health. Results: These interventions can be effective in changing the knowledge, attitudes, and behaviors of workers towards people with mental health problems, although further verification of these results is needed as they are limited to date. Discussion and conclusion Interventions to reduce stigma in the workplace could create more supportive work environments by reducing negative attitudes and discrimination and improving awareness of mental disorders.

Resumen Introducción: en Ecuador existen parámetros de calificación de discapacidad basados en la Clasificación Internacional del Funcionamiento de la Discapacidad y la Salud; sin embargo, los avances en investigación en el ámbito de la psiquiatría y la salud mental aún son escasos. Se empleó la Escala de Evaluación de Discapacidad de la Organización Mundial de la Salud para determinar el grado de discapacidad en población consultante. Materiales y métodos: estudio observacional, de corte transversal y correlacional. Usando un muestreo por conveniencia, se recogió información sobre discapacidad en una muestra de 297 adultos con trastornos mentales graves en contacto con servicios ambulatorios de psiquiatría. Se estimó un modelo de regresión lineal que determinó el aporte de variables sociodemográficas, clínicas y sociales. Resultados: el 89.2 % de la muestra presentó algún grado de discapacidad. El modelo multivariado final para el total de la muestra incluyó las variables explicativas edad (p = -0.234), escolaridad (p = -0.552), ser pensionado (p = 39.44), presencia de episodio depresivo actual (p = 21.654) y tener cuidador (p = 9.574), que explican el 37.46 % de la discapacidad de las personas con trastornos mentales graves atendidas en servicios de psiquiatría y salud mental en Quito. Conclusión: la discapacidad en personas con trastornos mentales graves que están en contacto con servicios de salud de Quito (Ecuador) involucra cambios en el desempeño de actividades en escenarios familiares y comunitarios. Se identificó una proporción de discapacidad moderada y severa que demanda respuestas institucionales que incluyan el acompañamiento de cuidadores y aborden barreras actitudinales.

Abstract Introduction: In Ecuador, there are disability qualification parameters based on the International Classification of the Functioning of Disability and Health; however, advances in the research fields of psychiatry and mental health are still scarce. For this particular study, The World Health Organization Disability Assessment Scale was used to determine the degree of disability in the consulting population. Materials and methods: The study design was an observational, cross-sectional and correlational study. Using convenience sampling, disability information was collected from a study population of 297 adults with severe mental disorders who were in contact with outpatient psychiatric services. A linear regression model was used to determine the contribution of sociodemographic, clinical, and social variables. Results: It was observed that 89.2% of the sample presented some degree of disability. The final multivariate model for the total sample included the explanatory variables of age (p = -0.234), schooling (P = -0.552), being retired (p = 39.44), presence of current depressive episode (p = 21.654), and having a caregiver (p = 9.574), which explained 37.46% of disability in people with serious mental disorders who were treated in psychiatric and mental health services in Quito. Conclusion: Disabilities in people with severe mental disorders who are in contact with health services in Quito (Ecuador) may involve changes in the performance of activities among family and community settings. We identified a proportion of moderate and severe disabilities that demand institutional responses, which includes the accompaniment of caregivers and also addresses attitudinal barriers.

Resumo Introdução: no Equador, existem parâmetros de qualificação de deficiência com base na Classificação Internacional do Funcionamento da Deficiência e da Saúde; no entanto, avanços em pesquisas no âmbito da psiquiatria e saúde mental ainda são escassos. Empregou-se a Escala de Avaliação da Deficiência da Organização Mundial da Saúde, para se determinar o grau de deficiência na população avaliada. Materiais e métodos: estudo observacional, de corte transversal e correlacional. Usando uma amostragem por conveniência coletou-se informação sobre deficiência em uma amostra de 297 adultos com transtornos mentais graves em contato com serviços ambulatórios em psiquiatria. Estimou-se um modelo de regressão linear que determinou a contribuição de variáveis sociodemográficas, clínicas e sociais. Resultados: 89.2% da amostra apresentou algum grau de deficiência. O modelo multivariado final para o total da amostra incluiu as variáveis explicativas idade (p=-0,234), escolaridade (p=-0,552), ser aposentado (p=39,44), presença de episódio depressivo atual (p=21,654) e, ter cuidador (p=9,574), explicando 37,46% da deficiência em pessoas com transtornos mentais graves atendidas em serviços de psiquiatria e saúde mental em Quito. Conclusão: A deficiência em pessoas com transtornos mentais graves que estão em contato com serviços de saúde em Quito (Equador) envolve mudanças no desempenho de atividades em cenários familiares e comunitários. Identificou-se uma proporção de deficiência moderada e severa que demandam respostas institucionais que inclua o acompanhamento de cuidadores e abordem barreiras de atitude.

Abstract Objective To evaluate the effectiveness of FBT in comparison with usual care in people with schizophrenia treated at an outpatient psychiatric department of a public hospital in Chile. Method Quantitative study, with a randomized, controlled clinical trial design (CTCT) and pre-post measurements, with two arms. Fifty-four people with schizophrenia and their primary caregivers, randomly assigned to experimental and control groups, were studied. The main outcome variable was social functioning. As secondary outcomes, clinical symptoms and treatment adherence in people with schizophrenia were evaluated. Expressed emotion was evaluated in the primary caregiver. Results FBT was effective in improving the social functioning of people with schizophrenia and decreasing expressed emotion in the primary caregiver, with a large effect size (d > 0.80). Conclusions The implementation of FBT as a protocolized intervention, complementing usual care, helps to improve psychosocial outcomes in people with schizophrenia and their caregivers.

Resumen Objetivo Evaluar la efectividad de la TFC, respecto de los cuidados usuales, en personas con esquizofrenia atendidas en un servicio de psiquiatría ambulatorio de un hospital público de Chile. Método Estudio cuantitativo, longitudinal, con diseño de ensayo clínico controlado aleatorizado (ECCA) y mediciones pre-post, a dos brazos. Se estudiaron 54 personas con esquizofrenia y sus cuidadores principales, asignados aleatoriamente a grupo control y experimental. La variable de resultado primaria fue el funcionamiento social; como resultados secundarios se evaluaron la sintomatología clínica y la adherencia a tratamiento del paciente y la emoción expresada en el cuidador principal. Resultados La TFC fue efectiva en el mejoramiento del funcionamiento social de la persona con esquizofrenia y en la disminución de la emocionalidad expresada en el cuidador principal, con un tamaño de efecto grande (d > 0.80). Conclusiones La implementación de la TFC, como intervención protocolizada y complementaria a los cuidados usuales, contribuye a mejorar resultados psicosociales en personas con esquizofrenia y en sus cuidadores.

Background: Simple and brief questionnaires with adequate psychometric properties are useful for the early detection of depressive disorders. Aim: To analyze the psychometric behavior of the Patient Health Questionnaire (PHQ-9) in Chile. Material and Methods: Data were collected from 1,738 adult patients, consulting in primary health care centers. The values obtained in the PHQ-9 were compared with those of the Composite International Diagnostic Interview (CIDI). Results: The mean score of PHQ-9 was 4.85 ± 5.57. Internal consistency indices were high. McDonald's ω coefficient of was 0.90 and Cronbach alpha 0.89. A confirmatory factor analysis showed a good fit of the one-dimensional model. Using a cutoff score of seven determined with the receiver operating characteristic (ROC) curve, the sensitivity and specificity of the instrument were 0.8 and 0.7, when compared with CIDI diagnoses. Conclusions: PHQ-9 is a useful instrument for the screening of depressive disorders in primary health care centers in Chile.

RESUMO Objetivo Descrever a disponibilidade de serviços locais de saúde mental em pequenas áreas de cobertura de saúde mental na região central do Chile com o uso de uma abordagem de baixo para cima (bottom-up). Métodos Os serviços de saúde mental de 19 pequenas áreas de cobertura de saúde mental em cinco distritos de saúde da região central do Chile que prestam assistência de saúde a mais de 4 milhões de habitantes foram avaliados com o uso da ferramenta DESDE-LTC (Description and Evaluation of Services and Directories in Europe for Long-Term Care – descrição e avaliação de serviços e diretórios na Europa para atenção a longo prazo). Trata-se de uma ferramenta para descrição padronizada e classificação dos serviços de saúde de assistência de longo prazo. Os dados desta avaliação foram comparados aos de um estudo de 2012 (DESDE-Chile) realizado com a finalidade de complementar outros estudos conduzidos em 2004 e 2012 ao nível nacional e regional com o uso do Instrumento de Avaliação dos Sistemas de Saúde Mental da Organização Mundial da Saúde (WHO-AIMS). Neste estudo, foi solicitado aos informantes-chave das autoridades de saúde ao nível nacional, regional e local que fizessem uma relação completa dos serviços ou instituições de saúde mental (das áreas da saúde, assistência social, educação, trabalho e habitação). A prestação de assistência local foi analisada segundo três critérios: disponibilidade de serviços, capacidade de vagas e capacidade da força de trabalho. Resultados O estudo verificou, nos cinco distritos de saúde, disparidades nos três critérios (disponibilidade e vagas e capacidade da força de trabalho) entre a zona urbana e rural e entre áreas urbanas vizinhas. A análise da disponibilidade de serviços revelou diferenças no peso entre os serviços residenciais e os serviços de assistência ambulatorial e atenção diária. Talcahuano poderia ser considerada a área de referência em atenção de saúde mental na região central do Chile, segundo os padrões de prestação de serviços e os critérios do modelo de atenção de base comunitária. A lista de serviços de saúde mental identificados no estudo difere da lista compilada no estudo de 2012 com o uso da WHO-AIMS. Conclusões Esta pesquisa sobre a prestação local de serviços de saúde mental em pequenas áreas de cobertura com o uso da ferramenta DESDE-LTC proporcionou dados que complementaram os dados coletados em outros estudos realizados ao nível nacional e regional com o uso da ferramenta WHO-AIMS. A abordagem de baixo para cima empregada neste estudo também poderia ser útil na avaliação de equidade e acessibilidade e do planejamento local.

ABSTRACT Objective To describe the availability of local mental health (MH) services in small MH catchment areas in Central Chile, using a bottom-up approach. Methods MH services of 19 small MH catchment areas in five health districts of Central Chile that provide health care to more than 4 million inhabitants were assessed using DESDE-LTC (Description and Evaluation of Services and Directories in Europe for Long-Term Care), a tool for standardized description and classification of LTC health services, in a study conducted in 2012 (“DESDE-Chile”) designed to complement other studies conducted in 2004 and 2012 at the national and regional level using the World Health Organization Assessment Instrument for Mental Health Systems (WHO-AIMS). Key informants from national, regional, and local health authorities were contacted to compile a comprehensive list of MH services or facilities (health, social services, education, employment, and housing). The analysis of local care provision covered three criteria—service availability, placement capacity, and workforce capacity. Results The study detected disparities in all three criteria (availability and placement and workforce capacity) across the five health districts, between urban and rural areas, and between neighboring urban areas. Analysis of service availability revealed differences in the weight of residential services versus day and outpatient care. The Talcahuano area could be considered a benchmark of MH care in Central Chile, based on its service provision patterns, and the criteria of the community care model. The list of MH services identified in this study differed from the one generated in the 2012 WHO-AIMS study. Conclusions This survey of local MH service provision in small catchment areas using the DESDE-LTC tool provided MH service provision data that complemented information collected in other studies conducted at the national/regional level using the WHO-AIMS tool. The bottom-up approach applied in this study would also be useful for the assessment of equity and accessibility and local planning.

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RESUMO Objetivo Compreender a lacuna de tratamento em saúde mental na Região das Américas examinando a prevalência de transtornos mentais, o uso de serviços de saúde mental e a carga global de doença. Métodos Foram utilizados dados de inquéritos comunitários de transtornos mentais na Argentina, Brasil, Canadá, Chile, Colômbia, Guatemala, México, Peru e Estados Unidos. Os dados publicados na Pesquisa Mundial de Saúde Mental foram utilizados para estimar a lacuna de tratamento. Para o Canadá, Chile e Guatemala, a lacuna de tratamento foi calculada a partir de arquivos de dados. A lacuna de tratamento média, média ponderada e mediana, e a prevalência de 12 meses por gravidade e categoria de transtorno mental foram estimadas para as populações adulta, infantil-adolescente e indígena em geral. Os anos de vida ajustados por incapacidade e os anos de vida com incapacidade foram calculados a partir do estudo Carga Global de Doença. Resultados Os transtornos mentais e de uso de substâncias foram responsáveis por 10,5% da carga global de doença nas Américas. A taxa de prevalência de 12 meses de transtornos mentais graves variou de 2% a 10% entre os estudos. A lacuna de tratamento média ponderada nas Américas para transtornos moderados a graves foi de 65,7%; em América do Norte de 53,2%; em América Latina de 74,7%; em Mesoamérica de 78,7%; e na América do Sul de 73,1%. A lacuna de tratamento para transtornos mentais graves em crianças e adolescentes foi superior a 50%. Um terço da população indígena nos Estados Unidos e 80% na América Latina não recebeu tratamento. Conclusão A lacuna de tratamento para a saúde mental continua sendo uma preocupação de saúde pública. Uma alta proporção de adultos, crianças e indígenas com doença mental grave permanece sem tratamento. O resultado é uma elevada prevalência de transtornos mentais e de carga global de doença.

ABSTRACT Objective To understand the mental health treatment gap in the Region of the Americas by examining the prevalence of mental health disorders, use of mental health services, and the global burden of disease. Methods Data from community-based surveys of mental disorders in Argentina, Brazil, Canada, Chile, Colombia, Guatemala, Mexico, Peru, and the United States were utilized. The World Mental Health Survey published data were used to estimate the treatment gap. For Canada, Chile, and Guatemala, the treatment gap was calculated from data files. The mean, median, and weighted treatment gap, and the 12-month prevalence by severity and category of mental disorder were estimated for the general adult, child-adolescent, and indigenous populations. Disability-adjusted Life Years and Years Lived with Disability were calculated from the Global Burden of Disease study. Results Mental and substance use disorders accounted for 10.5% of the global burden of disease in the Americas. The 12-month prevalence rate of severe mental disorders ranged from 2% – 10% across studies. The weighted mean treatment gap in the Americas for moderate to severe disorders was 65.7%; North America, 53.2%; Latin America, 74.7%; Mesoamerica, 78.7%; and South America, 73.1%. The treatment gap for severe mental disorders in children and adolescents was over 50%. One-third of the indigenous population in the United States and 80% in Latin America had not received treatment. Conclusion The treatment gap for mental health remains a public health concern. A high proportion of adults, children, and indigenous individuals with serious mental illness remains untreated. The result is an elevated prevalence of mental disorders and global burden of disease.

RESUMEN Objetivo Comprender la brecha en el tratamiento de la salud mental en la Región de las Américas mediante la revisión de la prevalencia de los trastornos de salud mental, el uso de los servicios de salud mental y la carga mundial de enfermedad. Métodos Se utilizaron datos de encuestas comunitarias de trastornos mentales de Argentina, Brasil, Canadá, Chile, Colombia, Estados Unidos, Guatemala, México y Perú. Se emplearon los datos publicados de la Encuesta Mundial de Salud Mental para estimar la brecha de tratamiento. Para Canadá, Chile y Guatemala, la brecha de tratamiento se calculó a partir de los archivos de datos. Se estimaron la brecha de tratamiento media, media ponderada, y mediana, y la prevalencia de 12 meses por gravedad y categoría de trastorno mental para las poblaciones generales de adultos, niños y adolescentes, e indígenas. Se calcularon los años de vida ajustados por discapacidad y los años vividos con discapacidad a partir del estudio Carga Global de Enfermedad. Resultados Los trastornos mentales y por consumo de sustancias representaron el 10,5% de la carga mundial de enfermedad en las Américas. La tasa de prevalencia de 12 meses de los trastornos mentales severos varió del 2% al 10% en los estudios. La brecha de tratamiento media ponderada en las Américas para los trastornos moderados a graves fue del 65,7%; en América del Norte de 53,2%; en América Latina de 74,7%; en Mesoamérica de 78,7%; y en América del Sur de 73,1%. La brecha de tratamiento para los trastornos mentales graves en niños y adolescentes fue superior al 50%. Un tercio de la población indígena en los Estados Unidos y el 80% en América Latina no recibieron tratamiento. Conclusión La brecha de tratamiento para la salud mental sigue siendo un problema de salud pública. Una gran proporción de adultos, niños y personas indígenas con enfermedades mentales graves continúan sin tratamiento. El resultado implica una prevalencia elevada de trastornos mentales y de la carga mundial de enfermedad.

Background The knowledge of predictive factors in depression should help to deal with the disease. Aim To assess potential predictors of remission of major depressive disorders (MDD) in secondary care and to propose a predictive model. Material and Methods A 12 month follow-up study was conducted in a sample of 112 outpatients at three psychiatric care centers of Chile, with baseline and quarterly assessments. Demographic, psychosocial, clinical and treatment factors as potential predictors, were assessed. A clinical interview with the checklist of DSM-IV diagnostic criteria, the Hamilton Depression Scale and the List of Threatening Experiences and Multidimensional Scale of Perceived Social Support were applied. Results The number of stressful events, perceived social support, baseline depression scores, melancholic features, time prior to beginning treatment at the secondary level and psychotherapeutic sessions were included in the model as predictors of remission. Sex, age, number of previous depressive episodes, psychiatric comorbidity and medical comorbidity were not significantly related with remission. Conclusions This model allows to predict depression score at six months with 70% of accuracy and the score at 12 months with 72% of accuracy.

Background: Depression is considered the second leading cause of disability worldwide. Aim: To describe the clinical characteristics and the evolution of major depressive disorder (MDD) in secondary care. To evaluate the association between socio-demographic and clinic variables with the first or recurrent major depressive events (MDE). Material and Methods: Clinical features, treatment, remission and duration of MDE were evaluated during a follow up lasting 12 months in 112 participants aged 44 ± 15 years (79% women). Patients were assessed as outpatients every three months at three psychiatric care centers of Chile. Clinical interviews were carried out using DSM-IV diagnostic criteria checklists and the Hamilton Depression Scale was applied. Results: Most patients were referred from primary care. The mean time lapse for referral to the secondary level was 10.8 months. Most patients had episodes that were recurrent, severe, with a high rate of psychosis, with suicide attempts and melancholic features and with psychiatric and medical comorbidities. Remission rate was 27.5%. In only 16 % of patients, the episode lasted six months or less. The group with recurrent episodes had different age, sex and clinical features. Conclusions: MDD treated at the secondary care level is severe and its symptoms are intense. The time lapse prior to referral was prolonged. Primary care management and referral of these patients should be studied more closely.

The child Behavior checklist/1.5-5 and the caregiver/teacher report Form are one of the most widely internationally recognized instruments to evaluate desadaptative behaviors which may affect the current and future development of preschool children. The psychometric behavior of both instruments was evaluated in a socioeconomically diverse sample of 550 chilean preschool children. In general, it was observed an analog behavior of both compared to the one obtained with studies in other societies. The confirmatory factor analysis showed a suitable adjustment of the original bifactor model. However, in the CBCL, the scores obtained are higher than in most of the countries and, comparatively, in both instruments, a greater effect of gender was observed. The findings obtained are analyzed and, normative and conceptual suggestions are given for the use of both instruments in preschool children in our country.

El Inventario de Conductas Infantiles 1.5-5 años (CBCL/1.5-5 por su acrónimo en inglés) y el informe del cuidador/educador (C-TRF por su acrónimo en inglés), son de los instrumentos más ampliamente reconocidos internacionalmente para evaluar conductas desadaptativas que pueden afectan el desarrollo presente y futuro de niños y niñas preescolares. Se evaluó el comportamiento psicométrico de ambos instrumentos en una muestra diversa socioeconómicamente de 550 preescolares chilenos. En general, ambos mostraron un comportamiento psicométrico análogo al obtenido con estudios en otras sociedades. Los análisis factoriales confirmatorios mostraron un ajuste adecuado del modelo bifactorial original. Sin embargo, en el CBCL/1.5-5 los puntajes obtenidos son más altos que en la mayoría de los países y, comparativamente, en ambos instrumentos, se observó un mayor efecto de género. Se analizan los hallazgos obtenidos, y se dan sugerencias normativas y conceptuales para el empleo de ambos instrumentos en niños y niñas preescolares en nuestro país.

WHO places Chile among countries with greater morbidity burden for psychiatric diseases in the world (23,2%). Major depression and alcohol consumption disorders hold the first and second place in disabilities attributed to adults. Almost a third of the population older than 15 years have suffered a psychiatric disorder during life span and 22,2% persons have had one in the last year. Anxiety disorders have more prevalence, followed by major depression and alcohol consumption disorders. Only 38,5% of those diagnosed receive some type of mental health care, by an specialist or a primary health care physician. In children and adolescent, prevalence of any psychiatric disorder is 22,5% (19,3% for boys and 25,8% for girls). These disorders are mainly disruptive and of anxiety. Prevalence is higher for children between 4 to 11 years (27,8%) than between 12 and 18 years, and this difference is due mainly to disruptive disorders. Prevalence of anxiety disorders is the second highest, even though less associated with disabilities, while many children and adolescents with affective disorders are disabled and only a fifth of persons with health care needs look for some form of care. Almost a fourth of those that use health care services did not present psychiatric diagnosis during last year. Co morbidity occurs in 27% of those with disorders, but only 7% have three or more diagnosis. Not addressing treatment gap in mental health has serious implications in public health.

La OMS coloca a Chile entre los países con mayor carga de morbilidad por enfermedades psiquiátricas (23,2%) en el mundo. La depresión mayor y los trastornos por consumo de alcohol ocupan el primer y segundo lugar en las discapacidades atribuidas entre adultos. Casi un tercio de la población mayor de 15 años ha sufrido un trastorno psiquiátrico en su lapso de vida y un 22,2% ha tenido uno durante el año pasado. Los trastornos de ansiedad son los más prevalentes, seguidos por depresión mayor y trastornos por consumo de alcohol. Solo el 38,5% de quienes han sido diagnosticados reciben algún tipo de servicio de salud mental, ya sea de un especialista o un médico de atención primaria. En niños y adolescentes, la prevalencia de cualquier trastorno psiquiátrico es de 22,5% (19,3% para niños y 25,8% para niñas). Estos trastornos son principalmente de ansiedad y disruptivos. La prevalencia es más alta entre niños de cuatro a once años de edad (27,8%) que entre aquellos de 12 a 18 años, y esta diferencia se debe principalmente a trastornos disruptivos. La prevalencia de trastornos de ansiedad es la segunda más alta, aunque menos asociada con discapacidades, mientras que muchos niños y adolescentes con trastornos afectivos están discapacitados y solo un quinto de las personas con necesidad de servicios buscan alguna forma de asistencia. Casi un cuarto de aquellos que usan los servicios no presentaron diagnóstico psiquiátrico durante el año pasado. La comorbilidad ocurre en el 27% de aquellas personas que presentan trastornos, pero solo el 7% tienen tres o más diagnósticos. No abordar la brecha de tratamiento en salud mental tiene serias implicaciones en la salud pública.

A OMS coloca o Chile entre os países com maior carga de morbidade por enfermidades psiquiátricas (23,2%) no mundo. A depressão maior e os transtornos por consumo de álcool ocupam o primeiro e segundo lugar nas descapacidades atribuidas entre adultos. Quase um terço da população maior de 15 anos tem sofrido um transtorno psiquiátrico em seu lapso de vida e cerca de 22,2% tiveram um durante o ano passado. Os transtornos de ansiedade são os mais prevalentes, seguidos por depressão maior e transtornos por consumo de álcool. Somente 38,5% daqueles que foram diagnosticados recebem algum tipo de serviço de saúde mental, seja de um especialista ou de um médico de atenção primária. Em crianças e adolescentes, a prevalência de qualquer transtorno psiquiátrico é de 22,5% (19,3% para meninos e 25,8% para meninas). Estes transtornos são principalmente de ansiedade e disruptivos. A prevalência é mais alta entre meninos de quatro a onze anos de idade (27,8%) do que entre aqueles de 12 a 18 anos, e esta diferença se deve principalmente a transtornos disruptivos. A prevalência de transtornos de ansiedade é a segunda mais alta, embora menos associada com descapacidades, enquanto muitos meninos e adolescentes com transtornos afetivos estão descapacitados e somente um quinto das pessoas com necessidade de serviços busca alguma forma de assistência. Quase um quarto daqueles que usam os serviços não apresentou diagnóstico psiquiátrico durante o ano passado. A comorbidade ocorre em 27% daquelas pessoas que apresentam transtornos, porém só 7% têm três ou mais diagnósticos. Não abordar a lacuna de tratamento em saúde mental tem sérias implicações para a saúde pública.

Background: Screening instruments are required for the detection of depressive disorders by primary care practitioners. Aim: To develop a screening instrument to detect depression, based on data gathered interviewing patients attending primary health care settings. Material and Methods: The instrument was constructed with data about factors associated or triggering a depressive disorder obtained from 3,000 patients consulting for general morbidity. All patients answered the Composite International Diagnostic Interview, (version 2.1, section depression) and an inventory containing 39 risk factors for depression, obtained from the literature. A multiple imputation method using chained equations was carried out. Using a binary logistic regression with backward selection, an equation for depression screening was obtained. The c-index was calculated to estimate discriminating power of the model. A shrinkage factor was estimated to adjust the predictive model. Results: Estimations were carried out with data from 2,552 patients with a median age of 47 years (73% women). Fifty five percent lived with a partner and 45% had basic studies. The method selected 14 significant predictors, with a shrinkage value of 0.861 and a c-index of 0.838 (95% confidence intervals 0.82-0.86). Conclusions: The instrument has adequate psychometric properties as a screening tool for depression in primary health care.

Background: Serotonin plays a central role regulating mood and on the development of depressive disorders. Aim: To study whether 5HTTLPR functional polymorphisms in the serotonin transporter gene or the Monoamine oxidase A gene (uMAOA) were risk markers for depression. Material and Methods: The Composite International Diagnostic Interview (CIDI) was applied to 1,062 consultants in primary health care centers aged between 18 and 75 years to establish the diagnosis of depression. A sample of saliva was obtained for DNA extraction and genetic analyses. Results: No association between the presence of depressive disorders and 5HTTLPR (ss) or uMAOA (3/3) risk genotypes was found. Psychological abuse and the presence of two or more life events were found to be predictors of depression in the studied sample. Conclusions: In this study, 5HTTLPR and uMAOA polymorphisms were not risk factors for depression. However, psychological abuse and the presence of two or more life events were risk factors for depressive disorders.

Postpartum depression (PPD) is a common condition worldwide and most of the available information is about treatment rather than prevention. This paper is an update on prevention and treatment of PPD. A simple review of the literature and a critical review of papers’ methodology and conclusions was carried out. There is a consensus of the preeminence of psychosocial factors in the genesis of PPD. Considering the complications when the condition is not treated, it is of the utmost importance to implement early detection and management strategies. The use of psychosocial preventive interventions is an alternative that has support in the literature and should be seriously considered.

Background: The reduction of major depression incidence is a public health challenge. Aim: To develop an algorithm to estimate the risk of occurrence of major depression in patients attending primary health centers (PHC). Material and Methods: Prospective cohort study of a random sample of 2832 patients attending PHC centers in Concepción, Chile, with evaluations at baseline, six and twelve months. Thirty nine known risk factors for depression were measured to build a model, using a logistic regression. The algorithm was developed in 2,133 patients not depressed at baseline and compared with risk algorithms developed in a sample of 5,216 European primary care attenders. The main outcome was the incidence of major depression in the follow-up period. Results: The cumulative incidence of depression during the 12 months follow up in Chile was 12%. Eight variables were identified. Four corresponded to the patient (gender, age, depression background and educational level) and four to patients' current situation (physical and mental health, satisfaction with their situation at home and satisfaction with the relationship with their partner). The C-Index, used to assess the discriminating power of the final model, was 0.746 (95% confidence intervals (CI = 0,707-0,785), slightly lower than the equation obtained in European (0.790 95% CI = 0.767-0.813) and Spanish attenders (0.82; 95% CI = 0.79-0.84). Conclusions: Four of the factors identified in the risk algorithm are not modifiable. The other two factors are directly associated with the primary support network (family and partner). This risk algorithm for the incidence of major depression provides a tool that can guide efforts towards design, implementation and evaluation of effectiveness of interventions to prevent major depression.

Background: Suicidal behavior ranges from ideation to consummation of suicide. In Chile, rates of suicide increased from 4.8 to 12.7/100,000 in the period 1992-2009. Aim: To evaluate the prevalence of suicidal behavior and its relationship with sociodemographic factors and psychiatric diseases. Material and Methods: The Composite International Diagnostic Interview (CIDI), was applied to a representative sample of 2,978 Chilean participants. The prevalence of four suicidal behaviors (thinking about or wishing death, suicide ideation and suicide attempts) and of psychiatric diseases according to the revised third version of the Diagnostic and Statistical Manual of Mental Disorders (DSM III-R), was calculated. Results: The lifetime prevalence of suicidal conception was 14.3% and the suicide attempt 7.7%, the latest associated with sex, age, school years, smoking habits, being married or having a relationship, depressive disorders, dysthymia, and alcohol, drug and tobacco dependence. Conclusions: Rates founded exceed international prevalence data and extrapolated to current rates of completed suicide, higher levels of suicidal behavior should be expected. Considering the associated disorders we can infer that it is essential a correct diagnosis and treatment of mood disorders and substance consumption to any other specific interventions.