Person centered care and Economic Deprivation: an epidemiological view of positive mental health in a less-developed country

Javier E. Saavedra, Victor Cruz, Juan E. Mezzich


Introduction: Positive health is one of the main components of person centered integrative diagnosis, as it involves the understanding of the patient's clinical condition within his context. Poverty is an important contextual factor that has been related to negative aspects of mental health in many studies, but little have been studied in regard to positive health, which should raised the importance of integrative care in poor persons. Objective: To identify in an adult population the extent to which poverty indicators are related to positive mental health indicators. Methods: The study consisted of a face-to-face household survey of 6555 community aged 18 years and older residents in five cities of the coast of Peru, selected trough a probabilistic three-stage sample procedure. The study integrated person-centered diagnosis proposals and other positive aspects of health as part of a comprehensive assessment which included an adaptation and complementation of the IGDA diagnostic suggestions through the following instruments: the MINI International Neuropsychiatric Interview ICD-10 version, the Quality of Life Index, the Mental Health Questionnaire (MHQ) elaborated in Colombia. Socioeconomic data were assessed using a question from the MHQ about the family capacity to supply essential needs with the household income. Relational statistical analyses between the different components of the diagnostic formulation and other positive aspects of health and socioeconomic condition were conducted. Results: The average age was 39 years, illiteracy rate was 3.6%; 59.2% of the sample were not working last week and the poverty line measured by the family capacity to supply essential needs with the household income was 25.5%. Economic deprivation was associated with worst indicators of positive mental health such lower scores on quality of life measures; more self-care functioning difficulties; lower satisfaction with personal aspects such as physical appearance, intelligence, education or work conditions; less feelings of happiness, more perceived psychosocial stressors with work, children and health; and lower family  integration. Conclusions: Implications of socioeconomic aspects in regard to the comprehensive diagnostic processes, treatment and research should be considered, particularly in less-developed countries. Health policies based on person centered care programs through the assessment of positive health could help to be more sensitive to more vulnerable sectors of the populations.

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