Methods

This project uses a mixed method approaches.

To obtain data related to a moment when the impact of the economic contraction is likely to have fully developed, we develop in 2015 a new epidemiologic study in a probability sub-sample of respondents to the national mental health survey, over-sampling those with a history of mental disorder.

All the individuals with a psychiatric disorder in the national survey and a 20% random sample of those without such disorders will be contacted for a follow-up interview.

To understand the effect of the economic crisis in the subgroup of people who presented a mental disorder in 2009, and the same effect on the people without a mental disorder in 2009, the sample now created corresponds to a sampling error of 3.5% with a level of confidence of 95% in the first subgroup, and a sampling error of 4.0%, with a level of confidence of 95% in the second subgroup.

To deal with the problem of presumed death panel, data analysis will include the introduction of weights propensity, in which participation in the 2nd wave is estimated by multivariate models and estimated probability of participation in the 2nd wave probabilities will be used to construct longitudinal weights.

Variables to be studied in the new survey will include:

  1. The same studied in 2009, namely 12-month prevalence of mental disorders, demographic factors, social support and neighborhood conditions, income and financial hardship, education, working conditions, unemployment and insecure work, critical life events, and family factors, use of services and psychotropic drugs in the last 12 months
  2. Other variables chosen to capture more detailed information on the changes that occurred since 2009 in family, work, employment, housing areas and use of services.

Instruments: See Xavier et al. Int J. Mental Health Syst. 2013, 7:19

To validate/extend information collected in 1, we will use a mixed strategy including:

  • Literature review
  • Deaths by suicide (2000-2008, 2009-2014) by municipality
  • Diagnosis Related Groups (DRGs) for mental disorders (2004-2008,2009-2014) by municipality
  • Analysis of rates of mental health services use at national, regional and local level (2008 -2014)
  • In-depth local case-studies, based on focus groups and semi-structured interviews with key actors in primary care services located in regional contexts specially affected by the crisis

An extensive revision of the literature will gather information on policies and interventions that proved to be effective in reducing mental health problems linked to economic crisis. Based on this information and on knowledge obtained about the main mental health problems associated with the crisis, we will develop and disseminate new policies, programmes and interventions, at national, regional and local levels, through a process involving health authorities, mental health services, primary care services and social agencies.