Centro de Investigación en Salud Mental Global, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, México.
Departamento de Psiquiatría, Universidad Autónoma de Madrid, España; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, España.
Arch Med Res. 2019 Nov;50(8):558-566. doi: 10.1016/j.arcmed.2019.12.008. Epub 2020 Feb 13.
In order to reduce the treatment gap of mental disorders, the World Health Organization (WHO) has proposed the mhGAP guidelines to be implemented globally.
To examine the effectivity of a training course based on the WHO-mhGAP guidelines to increase knowledge and readiness for identification and management of depression and suicide risk in primary care (PC) in Mexico.
PC clinicians were invited to participate in a traning course; before and after it, all completed an evaluation of knowledge of mhGAP and depression (0-10 points), and self-efficacy in suicide risk management (0-40 points), and were classified according to Prochaska and Diclemente transtheorical model in their particular stage of readiness for identification and management of these conditions.
The sample included 60 health professionals. Before training, clinicians had adequate knowledge of depression and its treatment (8.1 ± 1.66), but not on the mhGAP model and/or suicide risk management, which increased by the end of training (mhGAPpre:7.91 ± 2.19 vs. mhGAPpost:8.77 ± 1.34, p = 0.01; SuicidePRE:29.16 ± 9.35 vs. SuicidePOST:39.24 ± 6.83, p = 0.0001). Before training, most clinicians were at the contemplation stage (42.6% vs. 37.7% at the action and 19.7% at the precontemplation stage). By the end of the training, a decrease in the number of clinicians at both the contemplation and precontemplation stages (to 36.1% and to zero, respectively) and a significant increase of clinicians at the action stage (to 63.9%) was observed.
A training course based on the WHO-mhGAP could be an effective tool for increasing PC clinicians' willingness to implement mental health services.
为了缩小精神障碍治疗差距，世界卫生组织（WHO）提出了 mhGAP 指南，以在全球范围内实施。
检验基于 WHO-mhGAP 指南的培训课程在提高墨西哥初级保健（PC）中识别和管理抑郁和自杀风险的知识和准备情况方面的效果。
邀请 PC 临床医生参加培训课程；在培训前后，他们都完成了对 mhGAP 和抑郁知识（0-10 分）以及自杀风险管理自我效能（0-40 分）的评估，并根据 Prochaska 和 Diclemente 转变理论模型对他们识别和管理这些情况的准备阶段进行分类。
样本包括 60 名卫生专业人员。在培训之前，临床医生对抑郁及其治疗有足够的了解（8.1±1.66），但对 mhGAP 模型和/或自杀风险管理了解不足，培训结束时这些知识有所增加（mhGAPpre：7.91±2.19 vs. mhGAPpost：8.77±1.34，p=0.01；SuicidePRE：29.16±9.35 vs. SuicidePOST：39.24±6.83，p=0.0001）。在培训之前，大多数临床医生处于考虑阶段（42.6%，行动阶段为 37.7%，前考虑阶段为 19.7%）。培训结束后，考虑阶段和前考虑阶段的临床医生人数均减少（分别降至 36.1%和 0%），行动阶段的临床医生人数显著增加（增至 63.9%）。
基于 WHO-mhGAP 的培训课程可能是增强 PC 临床医生实施精神卫生服务意愿的有效工具。
