Influência de fatores sócio-demográficos, clínicos e institucionais na concessão de benefícios por incapacidade laborativa pelo setor de perícias médicas do INSS em Juiz de Fora – MG em requerimentos de segurados com diagnóstico de transtornos mentais

Abstract

PURPOSES: To analyse the importance of mental disorders among the requirements of sickness benefits and the influences of the government regulations from August/2005 (Estimated Social Welfare Coverage – “COPES”) and May/2006 (Postponement Petition – “PP”) over the profile of payments of these benefits; to characterize the insured citizens through social and demographic variables, clinics and social-security profiles and in terms of aspects related to space (place of expertise examination), to time (four periods) and to the categories of experts and their medical specific knowledge; to correlate the variables of conclusion (expertise examination conclusion and time of dissociation from work) to variables related to space, period of time, categories of experts and to clinic, social, demographic and social-security profile variables. METHOD: Retrospective analysis of initial expertise examinations that have taken place in Juiz de Fora (MG, Brazil) between July/2004 and December/2006 among the agencies “Largo do Riachuelo” and “São Dimas”, by officially registered doctors. Based on changes of government regulations and in the group of skilled doctors, the period was divided into four ones: 1) July/2004 to July/2005, before “COPES”, 2) August/2005 to November/2005, after “COPES” and with registered doctors, 3) December/2005 to April/2006, with no registered doctors and 4) May/2006 to December/2006, after “PP”. RESULTS: Mental disorders were the third reason of presumed incapacity at the Executive Management of the “INSS” (Brazilian National Social Insurance Institute) in Juiz de Fora. Insured citizens with mental disorder were more frequently females (66,8%) and linked to “INSS” as insured citizens with no connections with firms (41,2%) or unemployed ones (30,7%); they were, on the average, 44,3 years old, they had 14,4 years of affiliation to the “INSS” and 7,6 years of contribution. The more frequent diagnoses from the initial expertise examinations were minor humor disorders (39,6%) and anxiety disorders (34,5%); psychiatric comorbidities were most frequent (33,6%); diagnose changes, in relation to prior examination were identified in over 50% of the registrations. The frequency of acts of granting was reduced (from 81,9% in the first, to 49,5% in the fourth period), the medium number of renovations (from 3,5% in the first, to 1,7 in the fourth one) and the medium time of dissociation from work (from 397,4 days in the first to 247,6 days in the fourth); and it has been increased the reconsideration of health condition examination conclusions after the “COPES” (from 52,0% to 75,3%), with ulterior reduction in the fourth period (36,5%). Better chances of act of granting were associated to insured citizens up to 29 years old, employed and males; better chance of extended dissociation was associated to ages over 50, males, long evolution of disorder and more than 4 renovations of benefits; the chances of acts of granting and extended dissociation were bigger among insured citizens with serious disorders and with comorbidities. Skillful and registered psychiatrists have associated themselves to lesser chance of acts of granting and bigger chance of extended dissociation. CONCLUSION: This study suggests that the transformations verified at the profile of welfare grants in due more to concrete changes in registered doctors practice than only to changes of regulations or to working staff. It makes evident that skillful appraisals, mainly when carried out by psychiatrists, have proved to be suitable. It stands out possible relations between requirements of sickness benefits because of mental disorders in the work, informal or not, and the need of actions whose purposes could be to rescue and to consider valuable the working capacity of insured citizens with these same disorders, through a Professional Rehabilitation.