Efeitos da implantação dos Centros Atenção Psicossocial sobre as hospitalizações psiquiátricas de adolescentes e jovens por transtornos devidos ao uso de substâncias psicoativas no Brasil.

Abstract

Substance use disorders (SUD) are among the leading causes and risk factors for the burden of disease and disability worldwide, with a growing impact in the population aged 10 - 24 years. In Brazil, from the 2000s onwards, health care for people with substance use disorders was included in the mental health policy, starting to prioritize the provision of care in community-based services and social reintegration, articulating it in a network of services that replaced the classic psychiatric model. However, the care of children and adolescents with substance use disorders remains a critical point of psychosocial care. This thesis aimed to analyze the evolution and effects of the coverage of Psychosocial Care Centers (CAPS) on hospitalizations of adolescents and young people for substance use disorders in Brazil, being constructed in the format of three articles. Articles 1 and 2 consisted of the description and analysis of hospitalizations and coverage by CAPS, respectively, performing temporal trend analysis, seeking to identify possible joinpoints and estimate percentage changes, using the joinpoint regression. In article 1, it was found that hospitalizations for SUD accounted for 35.1% of hospitalizations for all Mental and Behavioral Disorders (MBD) in the period, with the highest frequency of records of male individuals (80.2 %), people between 19 and 24 years (61.5%) and race/skin color White (41.0%). Polydrug use disorders were the main cause of hospitalization (60.3%) and most occurred in Psychiatric Hospitals (64.1%). The national hospitalization rate was 32.2/100,000 in 2006 and 34.0/ 100,000 in 2018, with an Average Annual Percent Change (AAPC) of 0.2% (95%CI = -2.0; 2.5). There was an average annual reduction of 4.6% (95%CI = -8.7; -0.4) in hospitalization rates for alcohol use disorder and stability for the other drugs, an average annual increase of 7.5% (95%CI = 5.9; 9.2) in hospitalization rates in General Hospitals and a reduction of 3.1% (95%CI = -5.3; -0.7) in Psychiatric Hospitals. Article 2 indicated an expansion of CAPS among Brazilian municipalities, with unequal implementation among federative units and geographic regions. The type I CAPS were the most frequent in 2018 (48.9%), while CAPS with 24-hour operation remained incipient, with the CAPS III corresponding to 4.5% and the CAPS ADIII 4.1%. The national coverage showed an average annual increase of 7.4% (95%CI = 6.5; 8.5), with all regions showing positive and statistically significant mean variations, with changes in trends or a decrease in the magnitude of growth in coverage in the final years of the period. The article 3 applied negative binomial regression model with panel data. Municipalities showing Adequate coverage and presence of 24-hour CAPS reduced by 19% (95%CI = 0.76; 0.86) the rates of hospitalization for SUD. For all MBD, there was a reduction of 3% (95%CI = 0.95; 0.99) in municipalities with Adequate coverage and without 24-hour CAPS, increasing to 23% (95%CI = 0.74; 0.80) with this CAPS. There was a maintenance of the demographic profile and a small change in the nosological and care characteristics of hospitalizations, with a stability in the rates and an attenuation of the national expansion of CAPS. The findings suggest that the implementation of 24-hour CAPS reduces hospitalizations among adolescents and young people in Brazil, reaffirming the importance of these services to overcome the asylum/ classic psychiatric model and improve mental health care for children and adolescents.