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Case study of a psychosocial mental health intervention in São Paulo, Brazil

Garcia, Leon de Souza Lobo; (2018) Case study of a psychosocial mental health intervention in São Paulo, Brazil. Doctoral thesis (Ph.D), UCL (University College London). Green open access

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Abstract

Common mental disorders are responsible for a significant proportion of the global burden of disease. Differences in the availability of health care resources and the relevance of culture in the acceptability of treatments for mental disorders make it necessary to develop and evaluate interventions congruent with the context of specific settings. Group psychosocial interventions are a potentially cost-effective way of dealing with CMD in primary care. However, the literature describing and evaluating these interventions in low and middle-income countries is limited. This case-study describes Community Therapy (CT), a group psychosocial intervention developed in Brazil and hypothesized to improve mental health through social support. Although it is now widespread in the Brazilian primary health care, CT has not yet been submitted to systematic evaluation. This thesis analyzed data from an observational before/after design sampling 140 incident users from 12 CT groups located in primary care clinics and community settings of Sao Paulo, Brazil. Outcomes included mental health, perceived social support, quality of life, and social capital. Semi-structured interviews with CT users and facilitators as well as observation of CT sessions were also performed. The majority of respondents were female with few years of schooling, low income and a poor mental health. After 12 weeks of follow-up, there was an average twopoints improvement in mental health SRQ-20 scores (95% CI: 1.04-3.00, p<0.001) but no significant correlation with perceived social support change. Qualitative descriptions of CT, however, coincided with the mechanisms hypothesized to improve social support. Poor adherence and the lack of integration of CT users with conventional mental health care services were likely to have contributed to the modest change in the mental health of CT attenders. The effectiveness of CT should be further investigated in the context of a stepped-care multi-component intervention, whereby CT is included as its psychosocial component.

Type: Thesis (Doctoral)
Qualification: Ph.D
Title: Case study of a psychosocial mental health intervention in São Paulo, Brazil
Event: UCL (University College London)
Open access status: An open access version is available from UCL Discovery
Language: English
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health
URI: https://discovery.ucl.ac.uk/id/eprint/10042866
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