Avaliação do impacto dos Centro de Atenção Psicossocial (CAPS) nas hospitalizações psiquiátricas no Brasil no período de 2008 a 2019.

Abstract

Brazil currently has 2,755 CAPS units enabled, between 2019 and 2021. The purpose of this research was to analyze the effect of Psychosocial Care Centers (CAPS) on hospitalizations for mental disorders in the country. A longitudinal ecological study was carried out, using Brazilian municipalities as the unit of analysis, in the period 2008-2019. Data from 1,634 municipalities were considered, given the availability of data on psychiatric hospitalizations during this period. The period of the COVID-19 pandemic was excluded, due to the possible impact of this period on mental health. There were 3,889,568 hospital admissions due to psychiatric causes in Brazil between 2008 and 2019 in 1634 municipalities, with more than 40% due to disorders related to SCHIZOPHRENIA, followed by causes related to the use of ALCOOL. Males and people of white or mixed race/color make up the preponderant profile of those hospitalized throughout the data series in Brazil. Among Brazilian regions, the Southeast concentrated the majority of hospitalizations (52.53%), followed by the South (23.30%), Northeast (17.03%), Central-West (5.65%) and North (1 .49%). The south and northeast regions stood out for having average CAPS coverage higher than the values estimated in the present study for Brazil. In general, most municipalities in the present study presented, on average, CAPS coverage lower than 2.5 CAPS per 100 thousand inhabitants throughout the data panel considered (Figure 4). The Southeast region led in the number of hospitalizations for SCHIZOPHRENIA, ALCOHOLIC and PSYCHOACTIVES, totaling 1,344,104 hospitalizations, while the South had the highest hospitalization rates for MOOD DISORDERS, with 207,615 hospitalizations. Considering the general hospitalization model for Brazil, a positive association was detected between hospitalization rates per 100 thousand inhabitants and CAPS coverage, i.e., each increase in CAPS coverage in the municipalities was related to 1.30 times more hospitalization rates (RR: 1.30; p <0,001). hospitalizations, that is, in general, considering all AIHs, a reduction in hospital admissions due to psychiatric diagnoses was not observed with the increase in CAPS coverage, a different result from previous studies carried out. It was evident that most municipalities have similar CAPS coverage, although varying numbers of AIHs. Municipalities with low CAPS coverage (close to zero) have high numbers of hospitalizations, as well as those with the best rates. This may indicate a weak association between the two variables, although the positive effect observed in the models was significant. It is likely that increases in hospitalization rates with each increase in CAPS coverage are reflecting a characteristic of the health system or economic conditions of the municipality, given that, in general, the probability of zero hospitalizations occurring in a municipality is negatively related to the number of beds and GDP per capita. Therefore, it is expected that where there are more beds available, larger populations and better economic conditions, more hospitalizations will occur. Finally, analyzing the binomial part of the models by type of diagnosis, it is noticeable that the relationship between CAPS coverage and the probability of hospitalization rates equal to zero is similar to that observed in the general model for Brazil, i.e., the probability of a municipality not experiencing hospitalizations for the four main categories of psychiatric diagnoses reduces 15% on average for each increase in CAPS coverage. An exception was the northern region, which showed that each increase in CAPS coverage was associated with an increase in the probability of the municipality not experiencing hospitalizations in the four models by diagnosis (Figure 5). The same occurred for hospitalizations for ALCOOL in the southeast region. On the other hand, in the Central West Region, for CAPS coverage in the model for HUMOR, it is observed that each increase of one unit is associated with a decline of 14% (i.e. 0.86 – 1  100) in hospital admission rates. municipalities in this region. Even with the low coverage of CAPS in Brazilian municipalities, regions with the best coverage among municipalities, i.e. south and northeast (see Table 3), showed a reduction in hospitalization rates for MOOD and SCHIZOPHRENIA with each increase in coverage of these centers. Therefore, new studies are essential to seek different analyses, such as network management, analysis of the effectiveness of CAPS through matrix support, user and family reception, adherence to treatment, professional qualification, among other aspects.