I förarbeten till lagarna LVM och LPT framkommer det att det finns en problematik kring vården av personer som lider av både missbruk och psykisk ohälsa. Det framgår att samarbetet mellan psykiatri och socialtjänst i vissa avseende är att anse som bristfälligt och att brukarna faller mellan stolarna. Syftet med studien har varit att, genom granskning av rättskällorna, ta reda på och tydliggöra vad som ska ses som gällande rätt, för om en person med både missbruk och psykisk ohälsa ska få vård enligt LVM eller LPT. Metoden som har använts är en rättsvetenskaplig metod där fokus legat på granskning av rättskällorna. En rättsfallsstudie har även gjorts för att bredda bilden av hur rekvisiten för lagstiftningarna tillämpas. Resultatet har analyserats och redovisats utifrån den rättsdogmatiska metoden. Rättsfallen har tematiserats och redovisats i diagram. Studien visar att det finns gällande rätt kring ämnet, men att gällande rätt varierar beroende på personens situation. Huvuddraget i resultatet är att LPT vid allvarlig psykisk ohälsa bör gå före LVM. Vidare framkommer det att det inte finns något hinder, för att under en kortare period, vårdas enligt båda lagstiftningarna samtidigt. / In the preparatory works to the laws of LVM and LPT it has been pointed out that there is a problem regarding the care of persons that both suffer from an addiction as well as mental illness. It appears that the cooperation between psychiatry and social services is deficient and that the users are falling through the cracks. The purpose of the study has been, through review of the sources of law, to find out and define what is to be considered a correct, application of the law for a person that suffers from an addiction as well as a mental illness. Is it to be admitted to compulsory care and treatment according LVM or LPT? The method and material used for this purpose is the sources of law. To broaden the picture a study of court cases has also been made, regarding how the legislation is applied by a lower administrative court. The results has been analyzed and reported through the legal method. Court cases has been thematized and presented in different diagrams. The study shows that the outcome of the law varies depending on the person’s situation. The main feature of the result is that if someone is suffering from serious mental illness, LPT should be chosen instead of LVM. Further it is possible, during a shorter time, to be treated according to both LVM and LPT simultaneously.

Worldwide, fatal traffic injuries and drowning deaths are important problems. The aim of this thesis was to investigate the cirumstances of fatal and non-fatal traffic injuries and drowning deaths in Sweden including analysis of the presence of alcohol and drugs, which are considered to be major risk factors for these events. Data where obtained from the database of National Board of Forensic Medicine. In the first study, we investigated 420 passenger deaths from 372 crashes during 1993-1996. There were 594 drivers involved. In total, 21% of the drivers at fault were alcohol positive compared to 2% of drivers not at fault (p<0.001) (Paper I). During 2004-2007, crashes involving 56 fatally and 144 non-fatally injured drivers were investigated in a prospective study from Northern Sweden (Paper II). The drivers were alcohol positive in 38% and 21%, respectively. Psychoactive drugs were found in 7% and 13%, respectively. Benzodiazepines, opiates and antidepressants were the most frequent drugs found in drivers. Illict drugs were found 9% and 4% respectively, with tetrahydrocannabinol being the most frequent of these drugs (Paper II). We investigated 5,125 drowning deaths in Sweden during 1992-2009 (Paper III). The incidence decreased on average by about 2% each year (p<0.001). Unintentional drowning was most common (50%). Alcohol was found in 44% of unintentional, 24% of intentional, and 45% of undetermined drowning deaths. Psychoactive substances were detected in 40% and benzodiazepines were the most common substance. Illicit drugs were detected in 10%. Of all drowning deaths, a significantly higher proportion females commited suicide compared with males (55% vs. 21%, p<0.001). Suicidal drowning deaths (n=129) in Northern Sweden were studied further in detail (Paper IV). of these, 53% had been hospitalized due to a psychiatric diagnosis within five years prior to the suicide. Affective and psychotic disorders were the most common psychiatric diagnoses. Almost one third had performed a previous suicide attempt. One fourth had committed suicide after less than one week of discharge from hospital. Alochol was found in 16% and psychoactive drugs in 62% of these cases, respectively.  In conclusion, alcohol and psychoactive drugs are commonly detected among injured drivers and drowning victims, and probably play a role in these events. Most of the individuals that tested positive for alcohol and high blood concentrations, indicating alochol dependence or abuse. This association warrants futher attention when planning future prevention.

Several interventions have been developed and implemented to reduce the stigma attached to mental illness. However people who experience mental illness are still stigmatised in the communities in which they live, as well as in the healthcare centres where they receive treatment. The objective of this study was to critically synthesize the best available evidence regarding interventions to reduce stigma attached to mental illness. This study aimed to provide clinical practitioners with accessible information on interventions to reduce stigma attached to mental illness. Systematic review was chosen as a design method to identify primary studies that answer the following research question: What best evidence is available regarding interventions to reduce the stigma attached to mental illness? A thorough search was done on selected electronic databases: EBSCOhost; Science Direct; Web of knowledge; Scopus; Sabinet; ProQuest; SA Nexus; Cochrane; Google Advance Scholar were searched for primary studies that were published from 2001-2011, including the available 2012 literature and reference lists. The following key words were used in the search: Intervention, stigma, program, mental illness, mental disorder, psychiatric patients. During the selection of studies pre-determined inclusion and exclusion criteria were applied. Seventeen studies (n=17) were included for critical appraisal of methodology and quality using standard instruments from the Critical Appraisal Skills Program (CASP) the John Hopkins Nursing Evidence-Based Practice (JHNEBP) Research Evidence Appraisal Tool and Evidence Analysis Manual; Academy of Nutrition and Dietetics. All seventeen studies (n=17) were identified as evidence that answers the research question. Extraction of evidence, analysis and synthesis were conducted by means of the evidence class rating and grading of strength prescribed in the Evidence Analysis Manual (EAM, 2012:70). Findings indicated some interventions that reduce the stigma attached to mental illness. Using Web-based approaches and reading printed educational materials, documentary films and anti-stigma films, live and video performances, and humanising and traditional, naturalistic educational methods are effective in reducing stigma attached to mental illness for health professionals because there were no stigmatising attitude and social distance towards individuals with mental disorders. The German WPA (World Psychiatric Association) “Program against stigma and discrimination because of Schizo-phrenia – Open the doors” is effective in reducing stigma attached to mental illness for the general population. Combining education and video-based contact, in vivo contact and videotaped education, Active Minds and documentary films are effective in reducing stigma of mental illness for students. The use of puppets, psycho-education and contact (via DVD) and public education programs are effective in reducing stigma attached to mental illness for adolescents. The research was evaluated, a conclusion was given, limitations were identified and recommendations were formulated for nursing practice, nursing education and nursing research. / Thesis (MCur)--North-West University, Potchefstroom Campus, 2013.

Several interventions have been developed and implemented to reduce the stigma attached to mental illness. However people who experience mental illness are still stigmatised in the communities in which they live, as well as in the healthcare centres where they receive treatment. The objective of this study was to critically synthesize the best available evidence regarding interventions to reduce stigma attached to mental illness. This study aimed to provide clinical practitioners with accessible information on interventions to reduce stigma attached to mental illness. Systematic review was chosen as a design method to identify primary studies that answer the following research question: What best evidence is available regarding interventions to reduce the stigma attached to mental illness? A thorough search was done on selected electronic databases: EBSCOhost; Science Direct; Web of knowledge; Scopus; Sabinet; ProQuest; SA Nexus; Cochrane; Google Advance Scholar were searched for primary studies that were published from 2001-2011, including the available 2012 literature and reference lists. The following key words were used in the search: Intervention, stigma, program, mental illness, mental disorder, psychiatric patients. During the selection of studies pre-determined inclusion and exclusion criteria were applied. Seventeen studies (n=17) were included for critical appraisal of methodology and quality using standard instruments from the Critical Appraisal Skills Program (CASP) the John Hopkins Nursing Evidence-Based Practice (JHNEBP) Research Evidence Appraisal Tool and Evidence Analysis Manual; Academy of Nutrition and Dietetics. All seventeen studies (n=17) were identified as evidence that answers the research question. Extraction of evidence, analysis and synthesis were conducted by means of the evidence class rating and grading of strength prescribed in the Evidence Analysis Manual (EAM, 2012:70). Findings indicated some interventions that reduce the stigma attached to mental illness. Using Web-based approaches and reading printed educational materials, documentary films and anti-stigma films, live and video performances, and humanising and traditional, naturalistic educational methods are effective in reducing stigma attached to mental illness for health professionals because there were no stigmatising attitude and social distance towards individuals with mental disorders. The German WPA (World Psychiatric Association) “Program against stigma and discrimination because of Schizo-phrenia – Open the doors” is effective in reducing stigma attached to mental illness for the general population. Combining education and video-based contact, in vivo contact and videotaped education, Active Minds and documentary films are effective in reducing stigma of mental illness for students. The use of puppets, psycho-education and contact (via DVD) and public education programs are effective in reducing stigma attached to mental illness for adolescents. The research was evaluated, a conclusion was given, limitations were identified and recommendations were formulated for nursing practice, nursing education and nursing research. / Thesis (MCur)--North-West University, Potchefstroom Campus, 2013.

Our aim of this study was to investigate barriers and opportunities for people with mental disorders getting in to the labor market. This from experiences by people whose daily job contains work rehabilitation for this group in particular. On the basis of five qualitative interviews the results showed that prejudices towards people with mental disorders are a barrier for them to get a wage labor. Furthermore the results showed that low self-esteem within the target group and also high educational demands becomes a barrier to a wage labor. The results also showed that to focus on the healthy aspects may serve as an opportunity for people with mental disorders to get in to the labor market and be able to have a paid job. Another opportunity for this particular group consists of getting a subsidized employment. An increased knowledge among employers about the difficulties and strengths people with mental disorders may have to execute a job, can also serve as an opportunity for them to get an employment. / Vi har haft som syfte att undersöka hinder och möjligheter för personer som har ett psykiskt funktionshinder att få tillträde på den reguljära arbetsmarkanden. Detta utifrån upplevelser hos personer vars arbetsroll har inslag av arbetlivssinriktad rehabilitering för vår undersökta målgrupp.  Studien grundade sig på fem stycken kvalitativa intervjuer och resultaten visade på att fördomar som finns mot personer med ett psykiskt funktionshinder kan utgöra ett hinder för dem att få ett lönearbete. Vidare kunde även hinder kopplas till låg självkänsla hos målgruppen samt ökade krav till högre utbildning för att kunna få ett lönearbete. Resultaten visade även på att ha fokus på det friska i sig kan utgöra en möjlighet till lönearbete för personer med ett psykiskt funktionshinder. En annan möjlighet för den här målgruppen utgjordes av att få en anställning med lönebidrag.  En ökad kunskap bland arbetsgivare om vilka svårigheter samt styrkor personer med ett psykiskt funktionshinder kan ha i förhållande till att utföra ett arbete, kan också utgöra en möjlighet för dessa personer att få en anställning.

The role that culture and trauma plays in shaping mental health outcomes continues to dominate debate in the field of transcultural and post-conflict mental health. The broad aim of this thesis is to investigate key issues relevant to these two factors in relation to the Vietnamese. A meta-analysis of international epidemiological research indicated that countries of North and South East Asia appear to manifest low rates of mental disorder compared to English-speaking countries. A meta-regression analysis of research undertaken specifically with refugee and conflict-affected populations, confirmed a robust association between torture and general trauma and risk to mental disorder. The thesis then examines data from three population-based mental health surveys: 1,161 Vietnamese-Australian residents in the state of New South Wales; 3,039 Vietnamese resident in the Mekong Delta region of Vietnam; and 7,961 Australian-born persons drawn from a national survey. All surveys applied the Composite International Diagnostic Interview, with the Vietnamese surveys also applying the Phan Vietnamese Psychiatric Rating Scale, an indigenously-derived measure of mental disorder. The ICD-10 classification system yielded lowest rates amongst Vietnamese in the Mekong Delta, intermediate amongst Vietnamese in NSW; and highest rates amongst the Australian-born population. The Phan Vietnamese Psychiatric Rating Scale added a substantial number of cases in both Vietnamese samples. The findings suggest that sole reliance on a western-derived measure of mental disorder may fail to identify a cases of mental disorder across cultures. Trauma remained a substantial risk factor for mental disorder amongst Australian Vietnamese accounting for a substantial portion of the total burden of mental disorder in that population. The implications of these findings in developing a more refined model for understanding the mental health consequences of mass trauma across cultures are discussed.

Among all the causes of hospital admissions due to mental and behavioral disorders, abusive use of alcohol and other drugs represents one of the main reasons for hospitalizations. The growing number of users, and especially of drug dependents, makes abusive use of alcohol and other drugs a global public health problem. Thus, the present study had as objective to analyze the evolution of hospital admissions, due to abusive use of alcohol and other drugs, carried out in the State of Alagoas, from 2008 to 2015. An analytical, observational study of the ecological type was carried out, based on the information found in the national databases Of the Hospitalization System of the Unified Health System (SIH / SUS). Averages, proportions and gross rates were calculated. Among the first ten causes of hospitalizations due to mental disorders, the use of some type of drug is the second largest responsible (15.10%), second only to hospitalizations by Schizophrenia (57.25%). When specifically observed hospitalizations due to the use of drugs, it is verified that the disorders generated by the abuse of alcohol and multiple drugs concentrate 99,17% of hospitalizations. There was a strong trend of growth in these hospitalizations (R² = 0.8419), an increase of 90.56% when compared to the extremes of the evaluated period, regardless of the sex considered. In population terms, when the population is considered as a reference, in relation to the number of hospitalizations, there is no shocking increase related to these causes. However, in comparison to the other causes of mental disorders, an important increase in the accomplishment of such hospitalizations has been observed. Comparatively, men are the majority among hospitalizations for alcohol abuse (p = 0.0000), while women are more susceptible to the use of hypnotic sedatives (p = 0.0000), cocaine (p = 0.0000), volatile solvents (p = 0.0000), stimulants (p = 0.0000) and the use of multiple drugs (p = 0.0000). No difference was observed regarding the use of cannabinoids (p = 0.6283) and opiates (p = 0.0080). The volume of hospitalizations for alcohol and other drugs abuse is increasing, and it is necessary to elaborate and implement multisectoral preventive strategies, since this situation is directly related to the Social Determinants of Health. / Dentre todas as causas de internações hospitalares, decorrentes dos transtornos mentais e comportamentais, o uso abusivo de álcool e outras drogas representa um dos principais motivos de hospitalizações. O número crescente de usuários e principalmente, de dependentes de drogas, faz com que o uso abusivo de álcool e outras drogas seja um problema de saúde pública mundial. Dessa forma, o presente estudo teve como objetivo analisar a evolução das internações hospitalares, por uso abusivo de álcool e outras drogas, realizadas no Estado de Alagoas, no período de 2008 a 2015. Foi realizado um estudo analítico, observacional, do tipo ecológico, a partir das informações constantes nas bases nacionais do Sistema de Internações Hospitalares do Sistema Único de Saúde (SIH/SUS). Foram calculadas médias, proporções e taxas brutas. Entre as dez primeiras causas de internações devido aos transtornos mentais, o uso de algum tipo de droga é o segundo maior responsável (15,10%), perdendo apenas para as internações por Esquizofrenia (57,25%). Quando observadas, especificamente, as hospitalizações devidas ao uso abusivo de drogas, verificam-se que os transtornos gerados pelo uso abusivo do álcool e múltiplas drogas concentram 99,17% das internações. Observa-se uma forte tendência de crescimento nessas internações (R²= 0,8419), sendo verificado um incremento de 90,56% quando comparados os extremos do período avaliado, independente do sexo considerado. Em termos populacionais, quando se considera a população como referência, em relação ao número de internações, não se observa um aumento impactante relacionado a tais causas. No entanto, em comparação às demais causas de transtornos mentais, tem-se observado um importante aumento na realização das internações por uso de álcool e outras drogas. Comparativamente, os homens são maioria entre as hospitalizações por uso abusivo de álcool (p=0,0000), enquanto que as mulheres são mais suscetíveis ao uso de sedativos e hipnóticos (p=0,0000), cocaína (p=0,0000), solventes voláteis (p=0,0000), estimulantes (p=0,0000) e ao uso de múltiplas drogas (p=0,0000). Não foi observada diferença frente ao uso de canabinóides (p=0,6283) e opiáceos (p=0,0080). É crescente o volume de internações hospitalares por uso abusivo de álcool e outras drogas, sendo necessário elaborar e implementar estratégias preventivas multissetoriais, uma vez que tal situação tem relação direta com os Determinantes Sociais da Saúde.

Contexto: A influência das características do ambiente social de vizinhança nos transtornos mentais comuns (TMC) ainda é pouco estudada, principalmente em países em desenvolvimento como o Brasil, onde há poucos trabalhos sobre o tema. Objetivos: O objetivo geral foi investigar as relações entre as percepções de coesão social e segurança da vizinhança e transtorno mental comum, considerando-se as relações entre características individuais e de grupo bem como as medidas no nível agregado e no individual. Métodos: Essa pesquisa foi realizada com dados da linha de base (2008-2010) do Estudo Longitudinal da Saúde do Adulto - ELSA-Brasil, que é um estudo multicêntrico com 15.105 servidores civis, ativos e aposentados vinculados a seis instituições públicas de ensino superior e de pesquisa brasileiras. Foi utilizado o instrumento CIS-R, que permite rastrear o TMC e possibilita identificar seis categorias diagnósticas desse transtorno. Coesão social e segurança foram medidas por meio de escalas validadas de características autorreferidas de vizinhança. As covariáveis sexo, idade, estado civil, raça/cor, renda familiar per capita foram autorreferidas na entrevista de linha de base. O modelo de regressão de Poisson com variância robusta foi utilizado para estimar a razão de prevalência das associações entre os desfechos e as variáveis de exposição. Regressão logística multinível foi empregada considerando vizinhanças no nível 2 e os indivíduos no nível 1, para estimar o efeito aleatório de vizinhança e as razões de chance. Resultados: Resultados da percepção individual das características de vizinhanças indicaram associação entre pior percepção de coesão social e de segurança na vizinhança e transtornos mentais comuns, e essa associação permanece após o ajuste para as variáveis individuais, ou seja, participantes que percebiam morar em uma vizinhança com mais baixa coesão social e menos segura tiveram maior chance de apresentar TMC mesmo após ajustes para as covariáveis sociodemográficas. As variações entre as vizinhanças foram estatisticamente significativas no modelo vazio para TMC. Pequena porção da variância (2,3%) no TMC pode ser atribuída às vizinhanças. As estimativas de razão de chance obtidas no modelo mutiltinível mostraram uma variação significativa no TMC relacionada ao nível de coesão social e de segurança da vizinhança, que não pode ser totalmente explicada por fatores individuais, como sexo, idade, raça/cor, estado civil, escolaridade e renda familiar per capita. Conclusão: Esse estudo apresenta evidências da associação entre percepção de coesão social e segurança individual da vizinhança nos TMC, bem como entre as medidas agregadas da percepção de coesão social e segurança e TMC, mesmo após ajustes das variáveis individuais. Aproximadamente 2,3% da variabilidade na prevalência do TMC foram atribuídos ao contexto de vizinhança, e o restante ao nível individual, considerando o modelo “vazio”. / Context: The influence of the characteristics of the neighborhood social environment in common mental disorders (CMD), is poorly studied, mainly in developing countries such as Brazil, where there are few studies on the topic. Purposes: The general purpose was to investigate the relationships between the perceptions of social cohesion and neighborhood safety and common mental disorder, considering the relationships between individual and group characteristics as well as the ones measured in aggregate and individual level. Methods: This research was carried out using baseline data (2008-2010) from the Adult Health Longitudinal Study - ELSA-Brasil, which refers to the multicentric study with 15105 civil servants, active and retired ones linked to six Brazilian public higher education and research institutions. The instrument CIS-R was used which enables tracking the CMD and enables identifying six diagnosis categories of CMD. Social cohesion and safety were measured using validated scales of neighborhood self-referred characteristics. The covariates gender, age, marital status, race/color, per capita income were self-referred in the baseline interview. The Poisson regression model with robust variance was used to estimate the prevalence ratio of the associations between the outcomes and the exposition variables. Multilevel logistic regression was used considering neighborhoods in the level 2 and the individuals in the level 1 to estimate the neighborhood random effect and the chance ratios. Results: Individual perception results of neighborhood characteristics indicated association between worst perception of social cohesion and neighborhood safety perception and common mental disorders, and this association remains after the adjustment for the individual variables, that is, participants who noticed living at a neighborhood with lower social cohesion and less safe had a bigger chance to present common mental disorders even after adjustments for the socio demographic covariates. The variations between the neighborhoods were statistically significant in the empty model for CMD. A small portion of variance (2,3%) in the CMD can be attributed to the neighborhoods. The chances ratio estimates obtained in the multilevel model showed a significant variation in common mental disorders related to the level of social cohesion and neighborhood safety, which cannot be totally explained by individual factors such as gender, age, race/color, marital status, education and per capita income. Approximately 2,3% of variability in the prevalence of CMD was attributed to the neighborhood context and the rest to the individual level individual, considering the model as “empty”. Conclusion: This study presents evidences of the association between social cohesion and neighborhood individual safety perception in the CMD, as well as between the aggregate measures of social cohesion and safety perception and CMD, even after adjustment of the individual variables. About 2,3% of the variation in CMD prevalence was attributed to the context of neighborhood, and the rest to the individual level, considering the “empty” model.

Contexto: A influência das características do ambiente social de vizinhança nos transtornos mentais comuns (TMC) ainda é pouco estudada, principalmente em países em desenvolvimento como o Brasil, onde há poucos trabalhos sobre o tema. Objetivos: O objetivo geral foi investigar as relações entre as percepções de coesão social e segurança da vizinhança e transtorno mental comum, considerando-se as relações entre características individuais e de grupo bem como as medidas no nível agregado e no individual. Métodos: Essa pesquisa foi realizada com dados da linha de base (2008-2010) do Estudo Longitudinal da Saúde do Adulto - ELSA-Brasil, que é um estudo multicêntrico com 15.105 servidores civis, ativos e aposentados vinculados a seis instituições públicas de ensino superior e de pesquisa brasileiras. Foi utilizado o instrumento CIS-R, que permite rastrear o TMC e possibilita identificar seis categorias diagnósticas desse transtorno. Coesão social e segurança foram medidas por meio de escalas validadas de características autorreferidas de vizinhança. As covariáveis sexo, idade, estado civil, raça/cor, renda familiar per capita foram autorreferidas na entrevista de linha de base. O modelo de regressão de Poisson com variância robusta foi utilizado para estimar a razão de prevalência das associações entre os desfechos e as variáveis de exposição. Regressão logística multinível foi empregada considerando vizinhanças no nível 2 e os indivíduos no nível 1, para estimar o efeito aleatório de vizinhança e as razões de chance. Resultados: Resultados da percepção individual das características de vizinhanças indicaram associação entre pior percepção de coesão social e de segurança na vizinhança e transtornos mentais comuns, e essa associação permanece após o ajuste para as variáveis individuais, ou seja, participantes que percebiam morar em uma vizinhança com mais baixa coesão social e menos segura tiveram maior chance de apresentar TMC mesmo após ajustes para as covariáveis sociodemográficas. As variações entre as vizinhanças foram estatisticamente significativas no modelo vazio para TMC. Pequena porção da variância (2,3%) no TMC pode ser atribuída às vizinhanças. As estimativas de razão de chance obtidas no modelo mutiltinível mostraram uma variação significativa no TMC relacionada ao nível de coesão social e de segurança da vizinhança, que não pode ser totalmente explicada por fatores individuais, como sexo, idade, raça/cor, estado civil, escolaridade e renda familiar per capita. Conclusão: Esse estudo apresenta evidências da associação entre percepção de coesão social e segurança individual da vizinhança nos TMC, bem como entre as medidas agregadas da percepção de coesão social e segurança e TMC, mesmo após ajustes das variáveis individuais. Aproximadamente 2,3% da variabilidade na prevalência do TMC foram atribuídos ao contexto de vizinhança, e o restante ao nível individual, considerando o modelo “vazio”. / Context: The influence of the characteristics of the neighborhood social environment in common mental disorders (CMD), is poorly studied, mainly in developing countries such as Brazil, where there are few studies on the topic. Purposes: The general purpose was to investigate the relationships between the perceptions of social cohesion and neighborhood safety and common mental disorder, considering the relationships between individual and group characteristics as well as the ones measured in aggregate and individual level. Methods: This research was carried out using baseline data (2008-2010) from the Adult Health Longitudinal Study - ELSA-Brasil, which refers to the multicentric study with 15105 civil servants, active and retired ones linked to six Brazilian public higher education and research institutions. The instrument CIS-R was used which enables tracking the CMD and enables identifying six diagnosis categories of CMD. Social cohesion and safety were measured using validated scales of neighborhood self-referred characteristics. The covariates gender, age, marital status, race/color, per capita income were self-referred in the baseline interview. The Poisson regression model with robust variance was used to estimate the prevalence ratio of the associations between the outcomes and the exposition variables. Multilevel logistic regression was used considering neighborhoods in the level 2 and the individuals in the level 1 to estimate the neighborhood random effect and the chance ratios. Results: Individual perception results of neighborhood characteristics indicated association between worst perception of social cohesion and neighborhood safety perception and common mental disorders, and this association remains after the adjustment for the individual variables, that is, participants who noticed living at a neighborhood with lower social cohesion and less safe had a bigger chance to present common mental disorders even after adjustments for the socio demographic covariates. The variations between the neighborhoods were statistically significant in the empty model for CMD. A small portion of variance (2,3%) in the CMD can be attributed to the neighborhoods. The chances ratio estimates obtained in the multilevel model showed a significant variation in common mental disorders related to the level of social cohesion and neighborhood safety, which cannot be totally explained by individual factors such as gender, age, race/color, marital status, education and per capita income. Approximately 2,3% of variability in the prevalence of CMD was attributed to the neighborhood context and the rest to the individual level individual, considering the model as “empty”. Conclusion: This study presents evidences of the association between social cohesion and neighborhood individual safety perception in the CMD, as well as between the aggregate measures of social cohesion and safety perception and CMD, even after adjustment of the individual variables. About 2,3% of the variation in CMD prevalence was attributed to the context of neighborhood, and the rest to the individual level, considering the “empty” model.

Esse estudo elegeu como objeto de investigação a reabilitação psicossocial das pessoas com transtorno mental no contexto da reforma psiquiátrica brasileira. Para aproximação dessa realidade, analisamos as representações dos familiares produzidas a partir da experiência cotidiana nos serviços substitutivos de saúde mental e no domicilio junto ao parente com transtorno mental, explicitando os conflitos e contradições existentes e suas implicações na prática de cuidado da saúde e reabilitação psicossocial. Os sujeitos foram os familiares cuidadores de pessoas com transtorno mental severo e persistente, partícipes do grupo terapêutico de família dos Centros de Reabilitação Psicossocial (CAPS), na cidade de São Paulo (SP) - Brasil. Os achados foram coletados mediante entrevista semi-estruturada, observação e diário de campo e submetidos à Análise do Discurso com esteio no materialismo histórico-dialético mediante a qual foram extraídas as categorias temáticas. Constatamos que as concepções dos familiares acerca do transtorno mental, ainda, fortemente associadas aos signos estigmatizantes, determinam o modo como as famílias organizam o seu cotidiano, influenciando as atividades as relações interpessoais no âmbito familiar e social, os sentimentos, atitudes com relação ao sujeito acometido pelo transtorno, expectativas e perspectivas futuras no que refere à melhoria na qualidade de vida e inclusão social do sujeito acometido pelo transtorno mental e sua família. A maior parte dessas concepções é carregada de adjetivações negativas e adquirem conotação positiva, apenas, quando está presente a possibilidade de ganho secundário e a cura do transtorno mental é representada pela expectativa de retorno a normalidade e adaptação social / The focus of this study is the psychosocial rehabilitation of persons with mental disorders in the context of the Brazilian psychiatric reform. In order to gain insight into this reality, the study sought to perceive the familys representations which were produced from their daily experiences, dealing with substitutive services in mental health, and from the family member with the mental disorder, in the home, making explicit the existing conflicts and contradictions along with their implications in the practical care of psychosocial rehabilitation and health. The subjects were the care givers, being relatives, of those with severe, persistent mental disorder, who participated in the family therapeutic group of the Centers of Psycho-social Rehabilitation (CPR), in the city of Sao Paulo, SP, Brazil. The findings were collected through semi-structured interviews and diary field observation. The findings underwent discourse analysis with support in historical-dialectic materialism through which the thematic categories were extracted. We found that the families conceptions concerning mental disorder, still strongly associated with stigmatic signs, determined the manner in which they organized their daily life. These conceptions influenced the activities, the interpersonal relationships in the social, family context. They influenced the feelings and attitudes regarding the subject who carries the illness, as well as future expectations and perspectives regarding the improvement of the quality of life and the social inclusion of the individual suffering from the mental disorder, as well as of the family. The majority of these conceptions are latent with negative adjectives and acquire positive connotations only when there is a possibility of some secondary gain and when the cure of the mental disorder is represented by the return to normality and social adaptation