Percepção de cuidadores, fatores associados e participação no tratamento realizado em Centros de Atenção Psicossocial

Abstract

Informal caregivers provide an important portion of care to people with psychiatric disorders and the perception of change can be understood as the way someone identifies changes in the user resulting from the treatment received in CAPS. Measuring objective and subjective aspects of the change perceived by caregivers favors an expanded understanding of the effectiveness of the treatment that these services offer to the population. This master's thesis was composed of two empirical studies aimed at investigating the perception of informal caregivers regarding the changes presented by CAPS users in a city in the interior of Minas Gerais, the factors associated with this perception and how these family members participate in the treatment. The collection was carried out concurrently in the second half of 2019 with caregivers identified by users inserted in two CAPS located in the studied city. The results of the two studies were discussed with the theoretical framework of Health Psychology. The first study, with a quantitative and cross-sectional approach, aimed to characterize the change perceived by 50 informal caregivers of CAPS users with the treatment and to identify factors associated with this perception . The perceived change was assessed by the Perceived Change Scale - Family (EMP-Family) and a sociodemographic questionnaire and a functional autonomy checklist were also used. Descriptive and correlation analysis and two multiple linear regression models were performed (considering or not the crisis as a predictor). The global score of perceived change averaged 2.56 (SD + 0.34) and the improvement was perceived especially in the Psychological and Relationships dimensions of users. The factors associated with no crisis were: identifying with the role of caregiver, recreation activities psychiatric hospitalizations, time of diagnosis, treatment in other services, contacting CAPS professionals in crises and participation in treatment decisions. Considering the crisis, the associated factors were: relationship with the user, hospitalization, leisure activities, identifying as a caregiver, performing other treatments, hospitalizations, participating in treatment decisions, contacting CAPS in crisis and time of diagnosis. It is concluded that the family members perceive changes with the treatment in the CAPS and that the relationship of the family with the services can contribute to the treatment planning. The second qualitative study aimed to understand the perception of 19 caregivers about the changes that occurred as a result of the treatment at the CAPS and how they participate in the informal assistance of users. The instrument for data collection was a semi-structured interview script developed by the researchers. The interviews were conducted at the participants' homes, services, video call or call, audio recorded and analyzed through thematic content analysis proposed by Turato. The results were gathered into 13 two categories: perceptions about changes and treatment of users at CAPS; construction of learning and its expressions in the informal care of users. Caregivers, family members or collaborators were indicated, most of them women, not living in the same place as the users. Similarities were found in the context that precedes the treatment of users. The main focuses of improvement were: decreased symptoms; attempts at self-extermination, aggressiveness; sociability; coexistence with family and functional autonomy of users. Psychological, medical-psychiatric assistance, medications, guidance and reception of family members at meetings were considered responsible for the change. The identification with the role of caregiver occurred naturally and informal learning proved to be as important as formal knowledge, provided by CAPS and the social support network. The implementation of guidance practices, valuing participation in treatment decisions and expanded reception of caregivers could contribute to overcome obstacles such as the team's inaccessibility, evasion of users and burden in the provision of informal assistance.