CARE STRATEGIES AND PEOPLE WITH DEPRESSIVE SYMPTOMS: AN ETHNOGRAPHIC STUDY IN BRAZILIAN FAMILY HEALTH STRATEGY

Depression is one of the most prevalent disorders in primary care and the second most important cause of disease burden worldwide. A great debate takes place in Global Mental Health field, considering aspects of under/overdiagnosis and treatment of depression and the Inverse Care Law present in primary care settings. The aim of this research is to describe and to analyze the speeches and practices involved in care strategies offered to people with depressive symptoms in a Family Health Strategy setting in Rio de Janeiro, Brazil. This is an ethnographic study in two stages. In the first stage, 14 health care workers were in depth interviewed. We interviewed family physicians, family medicine residents, nurses and matrix support workers (one psychologist and one psychiatrist) from the same setting. We used deductive content analysis to analyze the interviews. The first results present differences between the strategies used by family physicians and family medicine residents to diagnose depression, ranging from more objective and screening test based approaches to subjective and qualitative based tools. All workers agreed about the importance of matrix support, but pointed difficulties in team working between physicians and psychologists as they have different theoretical frameworks. Important reflections were raised about social determinants of depressive symptoms and the risk of medicalization. Workers highlighted the importance of therapeutic groups and social support nets strengthening. The second stage will be a four month observational period when we intend to follow the work of the family health teams with these patients.