Portal de Periódicos da CAPES

Mental health in Portugal in times of austerity

2014; Elsevier BV; Volume: 1; Issue: 4 Linguagem: Inglês

10.1016/s2215-0366(14)70339-6

2215-0374

João Gama Marques, Sofia Brissos,

Employment and Welfare Studies

We read with interest the letter of our colleague Gonçalo Augusto,1Augusto GF Mental health in Portugal in times of austerity.Lancet Psychiatry. 2014; 1: 109-110Summary Full Text Full Text PDF Scopus (15) Google Scholar and therefore would like to congratulate the author and the editor for their interest in this subject. However, we confess some disappointment with Augusto's citations. Although the World Mental Health (WMH) survey, was an impressive effort in the study of mental illness prevalence, it had serious limitations, because “schizophrenia and other nonaffective psychoses…were not included in the core WMH assessment”.2Demyttenaere K Posada-Villa J Gasquet I et al.Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys.JAMA. 2004; 291: 2581-2590Crossref PubMed Scopus (2540) Google Scholar Regarding completed suicides, we remind readers that statistics have always been a problem in Portugal. There are important biases with doctors underdeclaring suicide as “unknown cause of death” in paper certificates, to avoid life insurance non-payment or religious stigma, especially in northern Catholic communities. To overcome this difficulty, the Ministry of Health has implemented an online and obligatory Death Certificate Information System (SICO).3http://www.theportugalnews.com/news/death-certificates-available-online-as-of-this-month/26744 (accessed July 14, 2014).Google Scholar Still, it is probably premature to affirm that “suicide rates have remained stable over the past few years in Portugal”. In fact, Augusto later cites a newspaper article regarding the disparity in official numbers between those of the National Institute of Legal Medicine and the Institute of Medical Emergency, suggesting that both attempted suicides and deaths by suicide seem to have been increasing. The second reference (Rodrigues et al) leads to a broken link and non-existent PubMed paper. Nevertheless, we found it, in Portuguese only, at the online repository of the Doutor Ricardo Jorge's National Health Institute.4http://repositorio.insa.pt/retrieve/6679/observacoes_7_2014_artigo8.pdf (accessed July 14, 2014).Google Scholar In sum, we would agree with Dr Augusto's statement that “unfortunately, no studies have been done on the effect of the country's economic and social crisis on the mental health of its people”. In fact, the Spring 2014 report by the Portuguese Health Systems Observatory, made public on June 30, concludes that Portugal stands before a conjugation of unfavourable factors in the area of mental health, worsened by the insufficient response, and maintained by an “apparently mediocre” information system;5http://www.observaport.org/aggregator/categories/1 (accessed July 14, 2014).Google Scholar therefore, we think it would be important to first have more accurate data on Portuguese mental health prevalence, and suicide statistics, before jumping to premature (and alarming) conclusions. Quality science is made with accurate numbers and citations. We declare no competing interests. Mental health in Portugal in times of austerityPortugal's 3-year financial rescue programme from the International Monetary Fund and European Union ended on May 17, 2014. After 3 years of heavy austerity measures, the time has come to look at some major health indicators and conclude on what effect this austerity has had on the health of the Portuguese, particularly on mental health. Full-Text PDF