Análise comparativa do registro médico-pericial do diagnóstico de transtornos mentais de segurados do Instituto Nacional do Seguro Social requerentes de auxílio-doença

Abstract

Objectives: Comparative analysis of the expertise recordings of diagnoses of the secured citizens of the Brazilian National Institute of Social Security (INSS) requiring sickness benefit and presenting mental disorders. Method: Retrospective study of the recordings of initial expertise examinations performed in the INSS offices in Juiz de Fora, MG, Brazil, between July/2004 and December/2006. Bivariate analyses according to the site where the expertise examination was conducted, category of the medical examiner and period of assessment were undertaken. Results: Mild or moderate depressive disorders and persistent mood disorders (39.6%) and anxiety disorders (34.5%) - milder conditions that would not impair labor ability - were the most frequently recorded diagnoses. Among comorbidities, mental disorders were more frequent (33.6%) than clinical ones, especially at the Riachuelo office, involving examiners admitted after 2005 and during the fourth period studied. Concordance rates between the present diagnosis and the previous one were low, lower than 50% in most cases, even for severe mental disorders with better defined clinical characteristics, such as psychoses. Higher concordance rates were seen for disorders due to the use of psychoactive substances and certified expertise examiners (66.7%). Conclusion: This study shows possible failures in the training of Juiz de Fora expertise examiners about the recording of the diagnoses of mental disorders of the secured citizens assessed.