Rede de apoio e discriminação: as diferentes associações com o adoecimento físico e mental em pacientes da Estratégia de Saúde da Família

Abstract

This study aimed to investigate the association between the support network and the experience of discrimination to physical illness (hypertension, diabetes and obesity) and psychological (anxiety, depression, depressive-anxiety disorder) in the context of the Family Health Strategy (FHS) in the municipalities of Rio de Janeiro and Sao Paulo. The present study used as a source of information the database from a previous search entitled Evaluation of a training model of mental health in primary care: comprehensive care in the practice of specialist orientation. The database was set up to collect data of that survey, to be our "n" composed of 1,466 respondents. To assess the diagnosis of physical illness, was completed a questionnaire by the doctor / nurse; for detection of mental disorders, the Hospital Anxiety and Depression Scale (HAD) was used; to find the kind of support network, we used the general questionnaire. In the latter, we have measured the amount of friends and relatives with whom they could count in difficult situations, participation in religious activities and collective leisure and volunteer work and meetings in community groups. To describe the support network, we used the Social Network Index (IRS) through the following categories: isolation and integration. To assess the discrimination, we used the general questionnaire that collected data on the perception of participants on discrimination. Data were analyzed in the SPSS 17. We observed the frequency distribution for each variable subsequently carrying out the joint distribution of frequencies - including the relative frequencies (percentages). These frequencies were calculated relative to the total number of participants. It also calculated the overall prevalence of each variable (with confidence intervals to 95%) including demographic data, economic, and type of diagnoses presented. There were bivariate analysis using the chi-square, linking the variables of Social Networking Index (isolation and integration) the outcomes: hypertension, diabetes, obesity, anxiety and depression, assessing the values of p. In the results, it was found that the pattern of support network was different between physical illness and mental disorders. They detected a statistically significant negative associations with diabetes isolation and integration with having anxiety / depression / depressive-anxiety disorder. As for the isolation of associations with having anxiety / depression / depressive-anxiety disorder were positive. About research on the experience of discrimination and its association with health, it was found that the pattern of association was different between the diagnoses of hypertension, obesity, anxiety and depression. The associations that occurred between discrimination and hypertension were negative, whereas the association between discrimination on obesity, anxiety and depression were all positive. All the above were statistically significant. Given the results point to the need for observation and intervention of these factors in patient care of the Family Health Strategy