Excesso de peso (sobrepeso e obesidade) e transtornos mentais comuns são importantes problemas de saúde pública no Brasil e no mundo. A associação entre ambos tem sido investigada por pesquisadores, porém os resultados ainda são conflitantes. Estudos realizados com nutricionistas têm dado maior ênfase à prática de atuação, entretanto, poucos abordaram questões de saúde desses profissionais, principalmente sobre o excesso de peso e sofrimento psíquico. Objetivo - Analisar a associação entre sobrepeso, obesidade e transtornos mentais comuns nesses profissionais. Métodos - Estudo seccional, realizado com 289 nutricionistas da rede pública de hospitais do município do Rio de Janeiro, no período de outubro de 2011 a agosto de 2012. A avaliação do excesso de peso corporal foi realizada com base no Índice de Massa Corporal (kg/m2) através da aferição de peso e altura, e os transtornos mentais comuns através do General Health Questionarie (GHQ-12). Variáveis sócio-demográficas, laborativas e de saúde também foram incluídas no estudo. Resultados - A prevalência de sobrepeso foi de 32,3% e de obesidade, 15,3%. A prevalência de transtornos mentais comuns (TMC) foi de 37,7%. A análise bruta demonstrou uma associação negativa entre transtornos mentais comuns e sobrepeso (OR 0,68; IC95% 0,39 1,20) e positiva para obesidade (OR 1,34; IC95% 0,65 2,75) que não se modificou quando ajustado pelas variáveis socioeconômicas (SES), laborativas e de saúde (OR= 0,60 IC95% 0.32 1,10) para sobrepeso e para a obesidade (OR= 1.09 IC95% 0,50 2,37). Conclusão - Os resultados do estudo destacam as altas prevalências de sobrepeso, obesidade e transtornos mentais comuns, bem como, a magnitude da associação entre os eventos, ambos sem significância estatística. Sugerimos novos estudos em que se possam identificar os mecanismos envolvidos nesta relação, bem como os fatores relacionados às condições de trabalho e de vida que possam estar afetando a saúde do nutricionista que é formado para cuidar da saúde população muitas vezes em detrimento da sua própria saúde. / Overwheight, obesity and common mental disorders are important public health problems in Brazil and worldwide. The association between both has been investigated by researchers, but the results are still conflicting ones. Studies done with Dietitians have put more emphasis on the practice itself, but only a few approached the health issues of these professionals, especially those related to overweight and psychic sufering. Aim The aim of this dissertation is to assess the association between overweight, obesity and common mental disorders among these professionals. Methods This is a cross study done with 289 dietitians at the public hospitals of the city of Rio de Janeiro, in the period from October 2011 to August 2012. The evaluation of corporal overweight was done by BMI (Kg/m2), through measurement of weight and height, and the common mental disorders were evaluated using the General Health Questionarie (GHQ-12). Socioeconomic, labour and general health variables were also included in the study. Results The prevalence of overweight was 32.3%, and that of obesity was 15.3%. The prevalence of common mental disorders (CMD) was 37.7%. The raw analysis showed a negative association between common mental disorders and overweight (OR 0.68; IC95% 0.39 1.20), and a positive association for obesity (OR 1.34; IC95% 0.65 2.75), which wasnt changed when adjusted by the socio-economic (SES), labor and general health variables (OR 0.60 IC95% 0.32 1.10) for overweight and (OR= 1.09 IC95% 0.50 2.37) for obesity. Conclusion The results of the study highlight high overweight, obesity and common mental disorders prevalence, as well as the magnitude of the association between the events, both with no statistical significance. Further studies to identify the mechanisms involved in this relationship are suggested, as well as studies to identify the factors related to the working and living conditions that might be affecting the Dietitians health, a professional trained to take care of the health of the population, often to the detriment of his own health.

Orientador: Heleno Rodrigues Corrêa Filho / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-17T20:14:07Z (GMT). No. of bitstreams: 1 Gaspar_AideAmabileCoelhodosSantos_D.pdf: 1338456 bytes, checksum: 924a14e015ffe48f69ef60be7e49609f (MD5) Previous issue date: 2011 / Resumo: Esta tese está inserida na linha de pesquisa sobre epidemiologia e trabalho. Estudou carregadores de um dos mercados da Companhia de Entrepostos e Armazéns Gerais de São Paulo. Nosso objetivo foi descrever como o trabalho pode determinar atitudes, vida e saúde mental em seus valores positivos e negativos. O panorama no qual o grupo se insere foi estudado por meio da observação participante e do método etnográfico registrados em diário de campo com informações subjetivas, sociais e das políticas intra-institucionais (artigo 1). Utilizamos questionário sócio-demografico e instrumentos validados para coletar dados sobre transtornos mentais comuns (TMC) e os relacionamos com dois determinantes: Primeiro a demanda psicológica no trabalho (artigo 2) e posteriormente somando dimensões das exigências totais do trabalho: demanda psicológica; atitude decisória; suporte social; demanda física e insegurança no trabalho (artigo 3). O primeiro artigo descreve os poderes individuais e de grupos no espaço social e geográfico do mercado. Destaca a posição subalterna da categoria em si, perante os órgãos de administração, e para si, diante de seu sindicato descentralizado. O segundo artigo elabora a relação forte entre TMC e dois aspectos psicossociais como a alta demanda psicológica (p=0,006) e o baixo suporte social (p=0,002). O terceiro artigo amplia a análise sobre todo o modelo demanda-controle relatando a alta exigência global no trabalho como associada à TMC (RP=2,15 (0,87-6,30); IC=95%). O fechamento da tese enfatiza a necessidade de penetrar esse espaço público, mas privatizado e carente, com a presença do estado, da organização social e do sistema único de saúde, articulando direitos no trabalho, autodefesa social, organização sindical e proteção contra riscos conhecidos. Seu fundamento é que os trabalhadores vendem sua força de trabalho e não podem perdê-la em detrimento do lucro e da competição de mercado / Abstract: This dissertation is linked to the research line on epidemiology and work. The study population were porters of one of a state company of wholesales food markets in upstate São Paulo (CEAGESP/RP). Our objective was to describe how the work may determine attitudes, life and mental health in its positive and negative values. The social setting in which this group was inserted was studied through participant observation and the ethnographic method registered in a field diary with subjective views, intra-institutional and social policies (article 1). A socio-demographic questionnaire and validated tools were used to collect data on Common Mental Diseases (CMD-TMC) and their relationships with two determinants: _ Psychological demands at work were examined at first (article 2), and at last other dimensions of total work demands were put together: psychological demand; decision latitude; social support; physical demand and unsafe job (article 3). The first article describes individual and group powers at the social and geographic space of the market. The submissive position of the work category in itself, towards the administration, and for itself, towards its own decentralized labor union is emphasized. The second article elaborates on the strong relationships of CMD-TMC with two psychosocial aspects: the high psychological demand (p=0,006) and the low social support at work (p=0,002). The third article encompasses all dimensions of the demand-control model in which the high global demand is associated with CMD-TCM (RP=2,15 (0,87-6,30); IC=95%). The dissertation closure emphasizes the need to make pervasive this public space, but also privatized and deprived, stressing the needed presence of the state, of social organization, and of the National Unified Health System, to articulate workers' rights, social auto defense, labor union organization, and protection against known hazards. The underpinnings are that the workers sell their workforce and they should not loose it in favor of profits and market competition / Doutorado / Epidemiologia / Doutor em Saude Coletiva

Este estudo teve como objetivos estimar prevalências de Transtornos Mentais Comuns (TMC) e de uso de psicofármacos em pacientes oncológicos em tratamento ambulatorial; verificar associações entre TMC e variáveis sociodemográficas, culturais, uso de psicofármacos e histórico de saúde; verificar associações entre uso de psicofármacos e variáveis sociodemográficas, culturais e histórico de saúde e; avaliar a qualidade de vida e fatores associados nestes pacientes. Trata-se de estudo transversal no qual foram entrevistados 403 pacientes do setor de quimioterapia de um hospital oncológico, com a utilização de questionário para coleta de dados sociodemográficos, culturais, histórico de saúde e uso de psicofármacos, além de instrumentos de rastreamento de Transtornos Mentais Comuns (SRQ- 20) e de avaliação de qualidade de vida (EORTC QLQ-C30). Para a abordagem de TMC e uso de psicofármacos como variáveis dependentes, foram realizadas as análises univariada (teste de Qui-quadrado) e regressão logística multivariada. A comparação dos grupos em relação à idade foi realizada por meio dos testes de Mann-Whitney e de Kruskal-Wallis. Para análise da qualidade de vida foi proposto modelo de regressão quantílica. Para todas as comparações adotou-se nível de significância de 5%. Os resultados revelaram prevalência de 31,5% de TMC e 25,8% de uso de psicofármacos. Por meio do teste Qui-quadrado identificou-se associação entre TMC e as variáveis sexo, escolaridade, renda familiar, uso de psicofármaco e histórico de cirurgia oncológica. Na regressão logística as variáveis sexo (OR=4,86; IC95% 2,27-10,42) e presença de comorbidades (OR= 2,12; IC95% 1,13-4,0) mostraram-se associadas a TMC. O uso de psicofármacos associou-se a sexo, situação de trabalho, histórico de cirurgias oncológicas, tempo de tratamento e comorbidades. Verificou se que as variáveis sexo (OR= 4,29; IC95% 2.03-9,08), situação de trabalho (OR=0,33; IC95% 0,15-0,75) e comorbidades (OR= 1,73; IC95% 1,05-2,84) exerceram contribuição estatisticamente significativa no modelo de regressão. Casos positivos para TMC apresentaram piores escores de qualidade de vida/saúde global e, entre esses, os que usavam psicofármacos apresentaram pior qualidade de vida do que os que não usavam. Identificou-se pior qualidade de vida em homens e em pessoas com baixo nível educacional. Os casos positivos para TMC apresentaram, também, piores capacidades física, emocional, cognitiva e social, pior desempenho de papel e maior proeminência dos sintomas fadiga, dor, insônia, perda de apetite e dispneia. Pacientes que usavam psicofármacos apresentaram piores funcionamentos físico, emocional e social e maior proeminência de fadiga e dispneia do que aqueles que não usavam tais medicamentos. Indivíduos sem renda ou com rendas mais baixas apresentaram piores funcionamentos cognitivo e social e maior proeminência de dor, insônia e dificuldades financeiras. Pacientes com nível de escolaridade mais baixo apresentaram pior funcionamento social e os analfabetos apresentaram maior proeminência de insônia. A idade influenciou no funcionamento físico. Pacientes que não tinham religião apresentaram maior proeminência de falta de apetite. De forma pioneira, este estudo identificou a forte influência de TMC e uso de psicofármacos na qualidade de vida de pacientes oncológicos que estavam realizando quimioterapia, agregando informações importantes à literatura / The objective of this study was to estimate the prevalence of Common Mental Disorders (CMD) and the use of psychotropic drugs in oncology patients undergoing outpatient treatment; verify sociodemographic and cultural variables, the use of psychoactive drugs and health history in association with CMDs; verify associations between the use of psychoactive drugs and sociodemographic, cultural and health history variables; evaluate the quality of life and factors associated within these patients. This was a cross-sectional study in which 403 patients from the chemotherapy sector of a cancer hospital were interviewed, using a questionnaire to collect sociodemographic, cultural data, health history and use of psychotropic drugs, as well as screening instruments for Mental Disorders Common (SRQ- 20) and Quality of Life assessment (EORTC QLQ-C30). For the approach to CMD and the use of psychotropic drugs as dependent variables, multivariate logistic regression and univariate analysis (Chi-square test) were used. A group comparison in relation to age was performed using the Mann-Whitney and Kruskal-Wallis tests. For Quality of Life analysis, a quantile regression model was proposed. For all comparisons, a significance level of 5% was adopted. The results showed a prevalence of 31.5% CMD and 25.8% use of psychoactive drugs. The Chi-square test identified an association between CMD and the variables of gender, schooling, family income, use of psychoactive drugs and history of oncological surgery. In the logistic regression the gender variables (OR=4.86; IC95% 2.27-10.42) and presence of comorbidities (OR= 2.12; IC95% 1.13-4.0) showed to be associated with CMD. The use of psychoactive drugs was associated with gender, employment status, history of oncologic surgeries, time of treatment and comorbidities. It was verified that the variables in gender (OR= 4.29; IC95% 2.03-9.08), employment status (OR=0.33; IC95% 0.15-0.75) and comorbidities (OR= 1.73; IC95% 1.05-2.84) exerted a significant statistical contribution to the regression model. Positive cases for CMD showed the lowest scores in regards to quality of life/overall health and among these, those using psychotropic drugs showed a lower quality of life than those who did not. A poor quality of life was identified in men and in people that had a low education level. Positive cases for CMD also showed the lowest in physical, emotional, cognitive and social abilities, poor role performance and greater prominence of the symptoms of fatigue, pain, insomnia, loss of appetite and dyspnea. Patients using psychoactive drugs had the worse physical, emotional, and social functions and greater prominence of fatigue and dyspnea than those who did not use such medications. Individuals without income or with low income showed the lowest cognitive and social functioning ability and a greater prominence of pain, insomnia and financial difficulties. Patients with a lesser level of education presented low social functioning abilities and those who were illiterate, presented a greater prominence of insomnia. Age had an influence in physical function abilities. Patients who did not have a religion showed a greater loss of appetite. In a pioneering way, this study has identified the strong influence of CMD and the use of psychoactive drugs on the quality of life of oncology patients undergoing chemotherapy, adding important research information to current study literature

Orientador: Cláudio Eduardo Muller Banzato / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-22T23:16:44Z (GMT). No. of bitstreams: 1 Araujo_LuisFernandoSilvaCastrode_M.pdf: 17028426 bytes, checksum: 19c4738a0813da9cb9bc34f3ae98874d (MD5) Previous issue date: 2013 / Resumo: A noção de causa é de grande importância na medicina e o uso de um vocabulário causal é praticamente inevitável. Afinal, intervenções como a prevenção e o tratamento dependem do conhecimento sobre as causas das doenças. Contudo, na literatura médica científica, frequentemente não se explicita quais são as noções de causa e os modelos causais empregados. Há ainda uma expectativa da descoberta de causas fortes, isto é, que seja necessário e suficiente o que nem sempre é o que constatamos na prática. No caso da psiquiatria, que nos interessa em particular, na maioria das vezes temos muitos fatores com influência causal fraca, cuja determinação é, na melhor das hipóteses, probabilística. Entender como se dá a cadeia causal dos transtornos mentais é um grande desafio. E a equação fica ainda mais complicada se incluirmos no raciocínio causal eventos que não se repetem, como, por exemplo, circunstâncias biográficas. OBJETIVO: O objetivo deste trabalho é analisar de forma filosoficamente informada às noções de causalidade presentes explícita ou implicitamente na literatura científica atual e estabelecer quais os modelos filosóficos de causalidade que predominam nestes textos. Abordo o modelo de causalidade do filósofo John L. Mackie como alternativa para a aplicação de modelos exclusivamente estatísticos de causalidade, como aparecem na literatura científica desde os trabalhos de Bradford- Hill (1964). MÉTODO E RESULTADOS: Realizei uma revisão da literatura filosófica e médica através das bases de dados relevantes (Philosophy Index e PubMed) e analisei os conceitos de causa utilizados, seja implícita ou explicitamente nos artigos. Também fiz uma busca ativa por livros de filósofos que tenham abordado o tema causalidade, bem como busquei artigos através das referências do material coletado. Há consequências da aplicação de certas ideias de causalidade sobre os dados empíricos, por exemplo, se devemos assumir ou não uma visão indeterminística de mundo é uma delas (distinção que aparece implicitamente entre os trabalhos de Koch e de Bradford- Hill, por exemplo). Outra consequência é a de que modelos estatísticos e de regularidade se aplicam com dificuldade em casos que não se repetem como acontece particularmente na psiquiatria. Além disto, a forma de investigação científica que escolhemos tem como consequência o acúmulo de informações com pouco poder explicativo sobre os eventos mentais. Exatamente por estas características da psiquiatria que utilizo o modelo do filósofo John L. Mackie de condição INUS, por ser capaz de lidar tanto com casos singulares quanto com relações estatísticas, assim como também é capaz de organizar de forma explicativa os dados científicos. Mackie propõe que nossa noção de causa inclui como causalmente relevantes elementos periféricos; causalidade é, para ele, "necessidade nas circunstâncias". Através desta idéia, define uma condição INUS como sendo um elemento necessário para um conjunto de circunstâncias que por sua vez é suficiente para o efeito em estudo. Detalho este modelo causal no decorrer do texto e, a título de exemplo, o aplico na Esquizofrenia e no Transtorno de Estresse Pós-traumático / Abstract: Causality is of great importance in medicine and the use of causal vocabulary is perhaps inevitable. After all, interventions such as prevention and treatment depend, to a large extent, upon the knowledge about the causes of diseases. However, medical scientific literature is seldom explicit about the notions of cause and causal models employed. There seems to be high expectations of finding strong causes for the diseases, i.e., causes that are necessary and sufficient, which are rarely seen in daily practice. In psychiatry, our main concern here, there are many weak causal factors whose determination is, at best, probabilistic. Understanding the causal chain of mental disorders is, therefore, a major challenge, and this equation becomes even more complex if we include in it singular events, such as biographical circumstances. OBJECTIVE: This work aims to analyze, in a philosophically-informed way, the explicit or implicit notions of causality in the current medical scientific literature and to find out which philosophical models of causality prevail in these texts. I also suggest that the causality model of the philosopher John L. Mackie is as an alternative to the exclusive use of statistical models in scientific papers, tendency observed since the seminal work of Bradford-Hill (1964). METHODS AND RESULTS: I reviewed medical and philosophical literature through the relevant databases (PubMed and Philosophy Index, respectively) and analyzed the concepts of cause used either implicitly or explicitly in the articles. I also made an active search through the references of the articles reviewed and considered as well books of philosophers who have addressed causality. There are important consequences of applying certain ideas of causality on empirical data, such as, for instance, deciding whether or not we should adopt an indeterministic stance of the world (distinction that implicitly appears in the contrast between the works of Koch and Bradford-Hill, for example). Another key consequence is that statistical models (which are based on regularity) face some difficulties when dealing with events that do not repeat, common occurrence in psychiatry. Moreover, the mainstream scientific research in psychiatry is leading to a growing set of empirical data with limited explanatory power about the causality of mental disorders. In that regard, the model of the philosopher John L. Mackie, called INUS condition, appear to be very helpful for rearranging the causal elements within a causal field. Mackie suggests that our notion of cause usually takes peripheral elements to be causally relevant; for him, causality is "necessity in the circumstances." Thus, he defines the notion of INUS condition as a necessary element within a set of conditions, set that is, at its turn, sufficient (though not necessary) for the effect. I explored the notion of INUS condition throughout the text and, to exemplify its feasibility and to stress its advantages, applied it to the hypothetical causal conceptualization of Schizophrenia and Post-Traumatic Stress Disorder / Mestrado / Saude Mental / Mestre em Ciências Médicas

Mental health care is critical and while governments are trying to increase awareness of the problem the available resources is not sufficient to confront the growing problem. The thesis proposes a design theory, using Gregor and Jones’s (2007) ‘Anatomy of a Design Theory’ framework, for the current mental illness dilemma that all societies are facing. The proposed solution is one of using information systems, together with domain knowledge and conventional instruments from the field of psychology to create a general screening tool. The design theory takes an ontological approach to defining the domain’s knowledge, using the MINI instrument along with expert knowledge to form the basis of the artifact. The artifact consists of four main entities: Background Information, Screening Questions, Pre-Requisite Questions and Other Questions. The thesis discusses the theoretical rationale for the screening took and then presents an instantiation of the artifact. This tool would be able to screen any person (with the exception of the mentally handicapped) to ascertain if they have a mental disorder as defined in the DSM-IV.

This study aimed to develop and test the feasibility of a peer-led parenting intervention for parents living in London in temporary accommodation, seeking help with managing behavioural difficulties of a child (aged 2–11). A structured, group-based intervention (‘Empowering Parents, Empowering Communities- Temporary Accommodation’) was delivered by peer facilitators to N=15 parents across three group cohorts. Twelve parents (80%) completed the group programme at first attempt; one parent completed on their second attempt after re-joining in a different cohort. A mixed-method formative evaluation was used. The intervention’s feasibility was assessed in terms of attendance and completion rates (% parents completing ≥6 sessions); acceptability was assessed by satisfaction measure and qualitative participant interviews; and potential for impact was assessed by parent-reported standardised measures of child behaviour, parenting behaviour, parental wellbeing, parenting stress and social support. Reductions in child behavioural difficulties and improved parenting knowledge and practices were reported on standardised measures. Improved parental outcomes were described in qualitative interviews. Participants were highly satisfied with the intervention. The study concluded that peer-led parenting groups are feasible and potentially effective interventions for parents living in temporary accommodation. These findings warrant further testing under controlled conditions.

Research suggests that interpersonal difficulties are reported by those who experience grandiose beliefs, however the processes and the relationship with the belief have seen limited exploration and are poorly understood. The present study aimed to explore the perceptions of interpersonal relationships and self-esteem of people who have grandiose beliefs and to explore if these accounts are consistent with existing theory. A qualitative design was employed using interpretative phenomenological analysis (IPA) to explore participants' subjective understanding of experiences. Semi-structured interviews were carried out with eight individuals who were purposively sampled. Transcripts were analysed using IPA. Four superordinate themes emerged: ‘Others as disregarding’; ‘Fragile sense of self’; ‘Lost in a frightening world’ and ‘Surviving’. The study found that participants' accounts were characterised by difficult interpersonal relationships in both early and adult life. The participants' sense of self was complex and lacking in coherence, thus previously used measures of “self-esteem” may not adequately capture the subtleties of the experiences. The sense of self was set in a social context characterised by feelings of powerlessness isolation and lack of trust. In the context of limited resources the results suggest the beliefs function to make sense of experiences and to help the participants survive. These findings confirm that the belief may, in part, serve to protect participants from poor “social self-esteem”. These findings provide avenues to further exploration of processes and provide recommendations for clinicians and services.

The study aimed to examine the relationship between wellbeing, burden, distress and third-wave factors, including self-compassion and psychological flexibility, in caregivers of people with psychosis. The study secondly aimed to trial a new brief group intervention, combining Acceptance and Commitment Therapy (ACT) and Compassion-focused Therapy (CFT) for this population. Twenty-nine participants were assessed at baseline on primary measures of wellbeing, distress, psychological flexibility and self-compassion. Secondary factors including burden and mindfulness were also collected. Correlation analyses were used. Fourteen participants completed the group in intervention and follow-up measures, and pre-post investigations were employed. Lower levels of psychological flexibility and self-compassion were related to lower levels of wellbeing and higher levels of burden and distress. There was a potential mediating effect of psychological flexibility on the relationship between self-compassion and wellbeing. The group intervention was acceptable to caregivers, and there were significant positive changes in self-compassion, distress, burden and mindfulness. The study adds to the existing data regarding wellbeing and burden in caregivers of people with psychosis. This study provides new insights into the factors of self-compassion and psychological flexibility within this population. The ACT with Compassion intervention is a promising, brief intervention which would benefit from further application and evaluation.

Cette recherche vise à donner une approche des troubles psychiques de la puerpéralité à partir de la psychanalyse d’orientation lacanienne. Ce travail se forge aussi comme une réponse aux idéaux de notre époque d’effacer toute la subjectivité des êtres parlants. Le pari de ce travail est donc d’élaborer une clinique prête à accueillir la subjectivité de chacune, tout en s’éloignant des théories valables pour toutes. Au-delà de la dialectique cause-effet et des conceptualisations des maladies puerpérales très définies et tranchées, on cherche à élucider les effets divers que l’événement de la maternité peut susciter et la façon dont chaque sujet peut renouer la déstabilisation provoqué par cet événement ; dès symptômes les plus anodins jusqu’aux déclenchements psychotiques les plus ravageants. Une telle orientation nous permet d’aborder ces diverses réponses à l’événement de la maternité d’une manière qui rend compte de l’unicité du sujet en question. / This investigation aims to provide a Lacanian approach to postpartum mental disorders. As such, our work responds to the dominant ideals of our epoch – that of erasing the unique subjectivity of each speaking being. The establishment of our clinical approach is based around a central wager, that of being able to welcome the subjectivity of everyone, all the while renouncing universal theories, which would be equally valid for all. Beyond the dialectic of cause-effect and conceptualizations of well defined and differentiated postpartum disorders, we seek to elucidate the diverse effects of the event of maternity; to elucidate the diverse ways in which each subject might come together again in the aftermath provoked by this event, from the most innocent symptoms to the most ravaging psychotic breaks. Such an orientation permits us to conceive of these diverse responses the event of maternity in a manner that takes into account the uniqueness of the subject in question.

Infants who experience multiple risk factors, such as preterm birth, developmental delay, and low socioeconomic status, are at greater risk for mental health problems. Mental health interventions for infants typically target infants from high-risk groups, and there is strong evidence that some intervention programs for infants can prevent long-term negative outcomes and promote long-term positive outcomes. Despite emerging research and federal initiatives promoting early intervention, minimal research has examined community-based mental health services during infancy. Improving the effectiveness and efficiency of routine care requires close examination of current practices. The current study characterized current usual care practices in infant mental health through a survey of mental health providers. Provider, practice, and client characteristics, provider use of intervention strategies and intervention programs, and provider attitudes toward and knowledge of evidence-based practices are described. Study findings are discussed in the context of previous usual care research. Implications and directions for future research are discussed.