MOOCS Saúde Mental e Trabalho - 29 - Avaliação e assistência em saúde mental e trabalho Pt 3

Hello! In the previous video, we looked at the importance and necessity of establishing a causal link between mental illness and work in order to provide more adequate care to the worker who seeks health care services. We also talked about the investigative steps needed to establish this relationship.

And finally, we talked about the classification of this causal relationship regarding the “Schilling Classification,” and etiological agents. In this video, We are going to talk about strategies, techniques, and some of the instruments we can use to assess causal relationships. The first fundamental instrument, which I have mentioned before, is occupational anamnesis.

Occupational anamnesis is a list of questions used to investigate the various aspects and elements of work. This anamnesis is quite extensive, and it needs to be extensive. We shouldn’t rush this anamnesis, it needs to be conducted carefully.

This means we may need more than one interview session with a worker to perform this anamnesis. Especially if we think of the public health service, where often a medical consultation with a nurse, or with another professional has a duration of 20 to 30 minutes. Therefore, further consultations may be necessary to fully accomplish an occupational anamnesis.

But that’s okay, the important thing is not to be in a hurry, the important thing is to do a meticulous and detailed interview. If you want to know more about occupational anamnesis, and have access to occupational anamnesis models, I indicate that you search for the model suggested by the Ministry of Health itself. There is also an occupational anamnesis model specifically focused on mental health, which is proposed by the authors, Mayte Raya Amazarray, Sheila Gonçalves Câmara, and Mary Sandra Carlotto, in the book: "Attention to Worker's Mental Health: Work-related Suffering and Psychological Disorders.

" In chapter four of this book, entitled "Research in Mental Health and Work in the Scope of Public Health in Brazil", these authors propose a set of questions about the subject’s occupational history focusing specifically on mental health issues. An important aspect is that this assessment, including the occupational anamnesis, needs to be carried out by a health team. And when I say team, I am referring to a multi-professional team that can guarantee an interdisciplinary approach because a single professional cannot deal with all the issues involved in the mental illness process.

So, there are several professionals who can contribute to this understanding: doctors, nurses, psychologists, social workers, pharmacists, and occupational therapists, for example. And this investigation can be done using various instruments. We can use interviews, anamnesis scripts, psychological tests, questionnaires, symptom checklists, those symptoms that are most prevalent in the working class.

In that same book, I quoted, "Attention to Worker's Mental Health: Work-Related Suffering and Psychological Disorders," in chapter five, Francisco Drmmond Marcondes de Moura Neto wrote the chapter entitled, "Reference Organization Experiences for the Diagnosis and Investigation of the Causal Relationship Between Work and Mental Health Problems. ” And in this chapter, he proposes a roadmap for investigating this relationship. It is a good example that can be used at this stage of the evaluation.

I have also brought here for you, some tips about more structured instruments that can also contribute to bring other research elements that may give us greater assurance in establishing the relationship between work and mental health, or mental disorders. These are scales that are validated and available. They can be used, Non-commercially, but for research purposes, and the evaluation of health services and they are easy to find.

So, we have, for example, Inventory of Work and Risk of Illness, (ITRA in Portuguese). This is an instrument composed of subscales that investigate the workers’ relationship with their work, aspects of work organization, and aspects related to strain, and workloads. We also have the possibility of the Self Report Questionnaire, known as SRQ-20, which is a WHO instrument for screening symptoms of anxiety and depression.

We also have the Negative Actions Questionnaire, which is an instrument used specifically for investigating occurrences of moral harassment at work. We have the Copenhagen Psychosocial Risk Questionnaire (COPSOQ), which is a widely used instrument to investigate the various psychosocial factors of risk at work. We also have the Depression, Stress, and Anxiety Identification Scale (DASS-21), which is an interesting instrument for tracking signs and symptoms of depression, stress, and anxiety.

So, we have talked about some useful instruments here. Each of these instruments provide sources of information that added up together, can help us compose a general picture of the situation, thus helping to establish a causal relationship. That's it for now.

Until the next video.