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Ethnoepidemiology and mental health: insights from Latin America. Salud Colect 2020; 16:e2786. [DOI: 10.18294/sc.2020.2786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 09/11/2020] [Indexed: 11/24/2022] Open
Abstract
In this essay, I explore methodological as well as theoretical implications of an ethno-epidemiological approach, aiming to integrate research findings in mental health into new conceptual models. With this objective, I first evaluate the roots and uses of the term “ethnoepidemiology” to designate three research strategies for scientific knowledge production: type I (studies of sociocultural risk factors and ethnically defined risk groups); type II (studies of lay models of distribution and occurrence of illness in populations); type III (ethnographic studies of projects and areas of epidemiologic research). As an illustration, selected methodological features of three studies in which I have participated are presented and discussed. I then elaborate upon methodological developments derived from this experience of doing research, generating new models for transcultural transdisciplinary research of mental health practices. Lastly, I comment on some broad implications of studying mental health problems from an integrated ethnographical and epidemiological point of view, in diverse and deeply unequal societies such as those of contemporary Latin America.
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Alcantara GDC, Coutinho ESF, Faerstein E. Pattern evolution of antidepressants and benzodiazepines use in a cohort. Rev Saude Publica 2020; 54:40. [PMID: 32294666 PMCID: PMC7112744 DOI: 10.11606/s1518-8787.2020054001887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 08/29/2019] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE In recent decades there has been an increase in the use of antidepressants (AD) and a decrease in the use of benzodiazepines (BDZ). Prevalence, cumulative incidence, and factors associated with the incidence of AD and BDZ use in a Brazilian population were estimated in this article. METHODS Data were collected with a self-administered questionnaire in a cohort of employees from a university in Rio de Janeiro. The prevalence of the use of AD and BDZ was calculated for 1999 (4,030), 2001 (3,574), 2006-07 (3,058), and 2012 (2,933). The cumulative incidences of the use of AD and BDZ between 1999 and 2007 were estimated by the Poisson models with robust variance estimates. RESULTS In 1999, the prevalence of the use of AD and BDZ were 1.4% (95%CI: 1.1–1.8) and 4.7% (95%CI: 4.1–5.4), respectively; in 2012, they were 5.4% (95%CI: 5.5–6.2) and 6.8% (95%CI: 6.0–7.8). The incidence of use, between 1999 and 2007, was 4.9% (95%CI: 4.2–5.7) for AD and 8.3% (95%CI: 7.3–9.3) for BDZ. The incidences of AD and BDZ use were higher among women and participants with a positive General Health Questionnaire. CONCLUSION In this population, the increase in the use of AD was not accompanied by a decrease in the use of BDZ, showing the prescriptions for psychotropic medication do not follow the currently recommended guidelines for treatment of common mental health disorders.
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Affiliation(s)
- Geisy de Carvalho Alcantara
- Universidade do Estado do Rio de Janeiro. Instituto de Medicina Social. Programa de Pós-Graduação em Saúde Coletiva. Rio de Janeiro, RJ, Brasil
| | - Evandro Silva Freire Coutinho
- Universidade do Estado do Rio de Janeiro. Instituto de Medicina Social. Departamento de Epidemiologia. Rio de Janeiro, RJ, Brasil
| | - Eduardo Faerstein
- Universidade do Estado do Rio de Janeiro. Instituto de Medicina Social. Departamento de Epidemiologia. Rio de Janeiro, RJ, Brasil
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Campanha AM, Ravagnani B, Milhorança IA, Bernik MA, Viana MC, Wang YP, Andrade LH. Benzodiazepine use in Sao Paulo, Brazil. Clinics (Sao Paulo) 2020; 75:e1610. [PMID: 32667494 PMCID: PMC7337218 DOI: 10.6061/clinics/2020/e1610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 04/02/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To report the prevalence and factors associated with the use of benzodiazepines in the general population and those with a mental health condition in the metropolitan area of São Paulo, Brazil. METHODS 5,037 individuals from the Sao Paulo Megacity Mental Health Survey data were interviewed using the Composite International Diagnostic Interview, designed to generate DSM-IV diagnoses. Additionally, participants were asked if they had taken any medication in the previous 12 months for the treatment of any mental health condition. RESULTS The prevalence of benzodiazepine use ranged from 3.6% in the general population to 7.8% among subjects with a mental health condition. Benzodiazepine use was more prevalent in subjects that had been diagnosed with a mood disorder as opposed to an anxiety disorder (14.7% vs. 8.1%, respectively). Subjects that had been diagnosed with a panic disorder (33.7%) or bipolar I/II (23.3%) reported the highest use. Individuals aged ≥50 years (11.1%), those with two or more disorders (11.2%), those with moderate or severe disorders (10%), and those that used psychiatric services (29.8%) also reported higher use. CONCLUSION These findings give an overview of the use of benzodiazepines in the general population, which will be useful in the public health domain. Benzodiazepine use was higher in those with a mental health condition, with people that had a mood disorder being the most vulnerable. Furthermore, females and the elderly had high benzodiazepine use, so careful management in these groups is required.
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Affiliation(s)
- Angela Maria Campanha
- Nucleo de Epidemiologia Psiquiatrica (LIM-23), Departamento e Instituto de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Departamento de Farmacia, Universidade Estadual de Maringa, Maringa, PR, BR
- *Corresponding author. E-mail:
| | - Beatriz Ravagnani
- Nucleo de Epidemiologia Psiquiatrica (LIM-23), Departamento e Instituto de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Igor André Milhorança
- Nucleo de Epidemiologia Psiquiatrica (LIM-23), Departamento e Instituto de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Instituto de Matematica e Estatistica, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Márcio Antonini Bernik
- Programa de Ansiedade, Departamento e Instituto de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Maria Carmen Viana
- Departamento de Medicina Social, Programa de Pos-Graduacao em Saude Coletiva, Centro de Estudos e Pesquisa em Epidemiologia Psiquiatrica (CEPEP), Universidade Federal do Espirito Santo, Vitoria, ES, BR
| | - Yuan-Pang Wang
- Nucleo de Epidemiologia Psiquiatrica (LIM-23), Departamento e Instituto de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Laura Helena Andrade
- Nucleo de Epidemiologia Psiquiatrica (LIM-23), Departamento e Instituto de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
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Abi-Ackel MM, Lima-Costa MF, Castro-Costa É, Loyola Filho AID. Uso de psicofármacos entre idosos residentes em comunidade: prevalência e fatores associados. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2017; 20:57-69. [DOI: 10.1590/1980-5497201700010005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 05/31/2016] [Indexed: 11/21/2022] Open
Abstract
RESUMO: Objetivo: Investigar a prevalência e os fatores associados ao uso de psicofármacos entre idosos. Métodos: O estudo, realizado em 2003, baseou-se no Inquérito de Saúde da Região Metropolitana de Belo Horizonte (RMBH). Participaram do estudo 1.635 idosos (60 anos ou mais) residentes nos municípios da RMBH, selecionados por meio de amostra probabilística complexa. Modelos de regressão logística foram utilizados para identificar os fatores associados ao uso de psicofármacos, considerando o nível de significância de 5,0%. Resultados: A prevalência de uso de psicofármacos foi de 13,4%, sendo 8,3% para uso de benzodiazepínicos e 5,0% para antidepressivos. Os fatores independentemente associados ao uso de psicofármacos foram sexo feminino (OR = 2,20; IC95% 1,49 - 3,27), relato de diagnóstico médico para depressão (OR = 6,42; IC95% 4,31 - 9,55), ter realizado 5 ou mais consultas médicas nos últimos 12 meses (OR = 2,15; IC95% 1,32 - 3,53) e afiliação a plano de privado saúde (OR = 2,69; IC95% 1,86 - 3,88). Conclusão: A prevalência observada foi semelhante ao verificado entre idosos brasileiros e o padrão de associações detectado foi consistente com o observado em populações idosas de países de maior renda, sendo o relato de diagnóstico médico para depressão o fator mais fortemente associado ao uso de psicofármacos.
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Blay SL, Fillenbaum GG, Peluso ET. Differential characteristics of young and midlife adult users of psychotherapy, psychotropic medications, or both: information from a population representative sample in São Paulo, Brazil. BMC Psychiatry 2015; 15:268. [PMID: 26511681 PMCID: PMC4625723 DOI: 10.1186/s12888-015-0651-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 10/16/2015] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE While the personal characteristics of users of psychotherapy and/or psychotropic medications have been examined, direct user comparison of these treatment approaches appears to be rare. Our aim is to ascertain extent of receipt of these services, and identify basic distinguishing characteristics of users. METHODS Information on demographics, lifetime and past 12 month use of mental health services, and presence of common mental disorders (CMD), was gathered in 2002 using a multi-stage sampling procedure that yielded a population-representative, community-resident sample (N = 2000, age 18-65) for São Paulo, Brazil. Analysis used descriptive statistics and logistic regression. RESULTS Overall, 9.3% reported receiving psychotherapy and/or psychotropic medication, 54.3% of whom did not meet CMD criteria. Of those meeting criteria for CMD (n = 455, 22.8%), 2.9% reported only psychotherapy, 10.1% reported only psychotropic medication, and 5.7% reported both. CMD was associated with use of psychotropic medication (psychotropic medication alone, Odds Ratio (OR) 3.58, 95% CI 2.33-5.52; together with psychotherapy, OR 4.17, 95% CI 2.34-7.44). CMD was not associated with use of psychotherapy. Users' distinguishing characteristics were: psychotherapy only--not married; psychotropics only--increasing age, female, not married; using both--only CMD status. Neither education nor income was associated with use. CONCLUSIONS Nearly 10% of all community residents age 18-65, but less than a fifth of the 23% with CMD, received psychotherapy and/or psychotropic medication. Non-married status increased odds of all treatment types, but CMD presence increased only odds of psychotropic and combined psychotherapy/psychotropic use, with odds of psychotropic only use increasing with age, and for women. Use was equitable with respect to education and income.
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Affiliation(s)
- Sergio L. Blay
- Department of Psychiatry, Federal University of São Paulo, (Escola Paulista de Medicina - UNIFESP), R. Borges Lagoa, 570, CEP 04038-020 São Paulo, SP BRAZIL
| | - Gerda G. Fillenbaum
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC USA
| | - Erica T. Peluso
- Universidade Anhanguera, Rua Maria Cândida, 1.813, CEP: 02071-013 São Paulo, SP Brazil
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Quintana MI, Andreoli SB, Peluffo MP, Ribeiro WS, Feijo MM, Bressan RA, Coutinho ESF, Mari JDJ. Psychotropic Drug Use in São Paulo, Brazil--An Epidemiological Survey. PLoS One 2015; 10:e0135059. [PMID: 26252517 PMCID: PMC4529275 DOI: 10.1371/journal.pone.0135059] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 07/17/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To estimate the prevalence of one month psychotropic drug use in São Paulo, Brazil, and to assess the gap treatment between the presence of mental disorders and psychotropic drug users. METHOD A probabilistic sample of non-institutionalized individuals from the general population of São Paulo (n = 2336; turnout: 84.5%) who were 15 years or older were interviewed by a trained research staff, applying the Composite International Diagnostic Interview 2.1 (CIDI WHO) (depression, anxiety-phobia, OCD\PTSD, alcoholism sections), and an inventory investigating psychotropic drug use during the 12-month and one-month periods immediately preceding the interview. Logistic models were fitted to investigate associations between psychotropic drug use as well as socio-demographic and clinical variables. RESULTS The one month prevalence of psychotropic drug use in São Paulo was 5.89%, the most commonly used drugs were antidepressants (3.15%) and tranquilizers (2.67%). A higher consumption of psychotropic drugs (overall, antidepressants and tranquilizers) was observed among women (OR:2.42), older individuals (OR:1.04), individuals with higher levels of formal education (1.06), and individuals with a family (OR:2.29) or personal history of mental illness (OR:3.27). The main psychotropic drug prescribers were psychiatrists (41%), followed by general practitioners (30%); 60% of psychotropic drugs were obtained through a government-run dispensing program. Most individuals who obtained a positive diagnosis on the CIDI 2.1 during the previous month were not using psychotropic medication (85%). Among individuals with a diagnosis of moderate to severe depression, 67.5% were not on any pharmacological treatment. CONCLUSION There is a change in the type of psychotropic more often used in São Paulo, from benzodiazepines to antidepressants, this event is observed in different cultures. The prevalence of use is similar to other developing countries. Most of the patients presenting a psychiatric illness in the month prior to testing were not receiving any sort of psychiatric medication. This may be explained by a failure to identify cases in primary care, which could be improved (and access to treatment could be facilitated) if professionals received more specialized training in managing cases with mental health problems.
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Affiliation(s)
- Maria Ines Quintana
- Universidade Federal de São Paulo—Escola Paulista de Medicina, Psychiatry Department, São Paulo, Brazil
- * E-mail:
| | - Sergio Baxter Andreoli
- Universidade Federal de São Paulo—Escola Paulista de Medicina, Psychiatry Department, São Paulo, Brazil
- Universidade Catolica de Santos, Santos, Brazil
| | | | - Wagner Silva Ribeiro
- Universidade Federal de São Paulo—Escola Paulista de Medicina, Psychiatry Department, São Paulo, Brazil
| | - Marcelo M. Feijo
- Universidade Federal de São Paulo—Escola Paulista de Medicina, Psychiatry Department, São Paulo, Brazil
| | - Rodrigo Affonseca Bressan
- Universidade Federal de São Paulo—Escola Paulista de Medicina, Psychiatry Department, São Paulo, Brazil
| | | | - Jair de Jesus Mari
- Universidade Federal de São Paulo—Escola Paulista de Medicina, Psychiatry Department, São Paulo, Brazil
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Campanha AM, Siu ER, Milhorança IA, Viana MC, Wang YP, Andrade LH. Use of psychotropic medications in São Paulo Metropolitan Area, Brazil: pattern of healthcare provision to general population. Pharmacoepidemiol Drug Saf 2015; 24:1207-14. [PMID: 26154976 DOI: 10.1002/pds.3826] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 05/22/2015] [Accepted: 06/04/2015] [Indexed: 11/06/2022]
Abstract
PURPOSE We estimate the proportion of psychotropic medication use (PMU) among adults in São Paulo Metropolitan Area, Brazil. We investigated whether socio-demographic factors, comorbidity, and disease severity influence PMU among individuals with psychiatric disorders. METHODS Data are from the São Paulo Megacity Mental Health Survey, a cross-sectional, population-based study, the Brazilian branch of the World Mental Health Survey Initiative. Trained lay interviewers face-to-face assessed psychiatric disorders and PMU through the Composite International Diagnostic Interview. Respondents were asked about use of healthcare service and prescribed medications for mental disorders in the previous year. Information on PMU was collected for 2935 adult residents in the area and among those with disorders who received treatment. RESULTS Around 6% of respondents reported PMU in the past year: hypnotics or sedatives were used by 3.7% and antidepressants by 3.5%. Among individuals with 12-month disorders, only 14% reported past year PMU. Gender, age, education, income, occupational status, comorbidity, and severity were significant predictors for PMU. Among those with 12-month DSM-IV disorders who obtained treatment in healthcare settings, almost 40% received medication only. Among those treated in specialty mental health service, around 23% received combination of medication and psychotherapy. CONCLUSION Our study has pointed out that the recent trend of access to mental healthcare in Brazil depicts unmet needs, characterized by a low prevalence of PMU among individuals with psychiatric disorders. Policies that improve appropriate access to prescribed drugs for those most in need are urgent public health priority.
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Affiliation(s)
- Angela Maria Campanha
- Section of Psychiatric Epidemiology (LIM-23), Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, SP, Brazil.,Department of Pharmacy, State University of Maringá, Maringá, PR, Brazil
| | - Erica Rosanna Siu
- Section of Psychiatric Epidemiology (LIM-23), Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Igor André Milhorança
- Institute of Mathematics and Statistics, University of São Paulo, São Paulo, SP, Brazil
| | - Maria Carmen Viana
- Department of Social Medicine, Health Sciences Center, Federal University of Espírito Santo, Vitória, ES, Brazil
| | - Yuan-Pang Wang
- Section of Psychiatric Epidemiology (LIM-23), Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Laura Helena Andrade
- Section of Psychiatric Epidemiology (LIM-23), Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, SP, Brazil
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Factors associated with antidepressant, anxiolytic, and other psychotropic medication use to treat psychiatric symptoms in the city of São Paulo, Brazil. Int Clin Psychopharmacol 2014; 29:157-65. [PMID: 24172159 PMCID: PMC3969784 DOI: 10.1097/yic.0000000000000008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The objective of this study was to examine the prevalence and characteristics of adult psychotropic medication use in São Paulo, Brazil. Information on lifetime and 12-month psychotropic medication use, and psychiatric status was obtained from a representative sample of 2000 adults aged 18-65 years in São Paulo, Brazil. Lifetime and 12-month use of psychotropic medications was 16.8 and 7.1%, respectively. Of the 22.8% of patients with current psychiatric problems, 29.5% reported lifetime use and 15.8% (5.6% of the sample) reported 12-month use (anxiolytics: 2.7%, antidepressants: 1.8%, alternative medicines: 0.9%, antipsychotics: 0.4%, mood stabilizers: 0.4%, hypnotics: 0.3%; multiple class use occurred). The most frequent prescribers were psychiatrists and general practitioners. Determinants of use included identification as a psychiatric case (four-fold increased odds), being female (three-fold increase), age (4-5% per additional year), and lower odds if married. Education, employment status, and birth in São Paulo were not associated with use. Income did not affect anxiolytic use, but antidepressant and alternative medicine use was associated with higher income. These results show that psychotropic drug use was comparatively low. Only 15.8% of patients with psychiatric problems reported recent psychotropic use. Comparable with other studies, use was greater among women and increased with age.
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da Rosa Beltrão SM, Beltrão Gigante L, Beltrão Zimmer D, Roberto Zimmermann P, Schmoeller D, Batistella F, Luiz Staub H. Sintomas psiquiátricos em pacientes com lúpus eritematoso sistêmico: frequência e associação com atividade da doença com o uso do Questionário de Morbidade Psiquiátrica em Adultos. REVISTA BRASILEIRA DE REUMATOLOGIA 2013. [DOI: 10.1590/s0482-50042013000400003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Meng X, D'Arcy C, Tempier R. Trends in psychotropic use in Saskatchewan from 1983 to 2007. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2013; 58:426-31. [PMID: 23870725 DOI: 10.1177/070674371305800708] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE There has been little research reported on trends in the use of a full spectrum of psychotropics in a general population. We provide an overview of trends in psychotropic use over a 24-year period for Saskatchewan. METHODS Data were drawn from the Saskatchewan Ministry of Health administrative data files. It covers antidepressants (ADs), antipsychotics, mood stabilizers, anxiolytics, stimulants, and cholinesterase inhibitors in outpatient settings. We analyzed data from 9 triennial years from 1983 to 2007. Descriptive statistics were used. RESULTS Among the Saskatchewan population in our study, 8.38% were prescribed at least 1 psychotropic in 1983. The prevalence decreased to 7.44% in 1989, then gradually increased to 12.90% in 2007. We found a continuous increase in the number of psychotropic prescriptions for both males and females. The trend became more marked during the 1990s. Females used more psychotropics. Family physicians were the major prescribers, and their prescriptions dramatically increased over the period. There was an increase in the prescribing of all psychotropics except for anxiolytics. AD prescriptions dramatically increased, especially from 1995 onward. The proportion of patients with 8 to 11 and 12 or more prescriptions per year also gradually increased, whereas the proportion of patients with less than 3 prescriptions per year decreased. CONCLUSIONS AD prescriptions are the major reason for the increasing trend of psychotropic use. Given the major role of family physicians in the use of psychotropics, the need for appropriate training and continuing education is reinforced.
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Affiliation(s)
- Xiangfei Meng
- Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
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Quintana MI, Andreoli SB, Moreira FG, Ribeiro WS, Feijo MM, Bressan RA, Coutinho ESF, Mari JJ. Epidemiology of psychotropic drug use in Rio de Janeiro, Brazil: gaps in mental illness treatments. PLoS One 2013; 8:e62270. [PMID: 23690934 PMCID: PMC3653914 DOI: 10.1371/journal.pone.0062270] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 03/19/2013] [Indexed: 12/05/2022] Open
Abstract
Objective Estimate the prevalence of psychotropic drugs use in the city of Rio de Janeiro, Brazil, and establish its relationship with the presence of mental disorders. Methods A probabilistic sample of non-institutionalized individuals, from the general population of Rio de Janeiro (n = 1208;turn out:81%), 15 years or older, who were interviewed using the Composite International Diagnostic Interview 2.1 (depression, anxiety-phobia, OCD\PTSD, alcoholism sections), and asked about their psychotropic use during a 12 and one-month period before the interview. Data were collected between June/2007-February/2008.The prevalence was estimated with a confidence interval of 95%. The associations between psychotropics use and mental disorders were analyzed through a logistic regression model (Odds Ration – OR). Results The one-month prevalence of psychotropic drug use was 6.55%, 3.19% for men and 9.13% for women. Antidepressants were the most frequently used drug (2.78%), followed by anorectics (1.65%), tranquilizers (1.61%) and mood stabilizers (1.23%). General practitioners issued the highest number of prescriptions (46.3%), followed by psychiatrists (29.3%); 86.6% of the psychotropic drugs used were paid for by the patient himself. Individuals with increased likelihood of using psychotropic drugs were those that had received a psychiatric diagnosis during a one-month period before the study (OR:3.93), females (OR:1.82), separated/divorced (OR:2.23), of increased age (OR:1.03), with higher income (OR:2.96), and family history of mental disorder (OR:2.59); only 16% of the individuals with a current DSM IV diagnosis were using a psychotropic drug; 17% among individuals with a depression-related diagnosis and 8% with Phobic Anxiety Disorders-related diagnosis used psychotropics. Conclusion Approximately 84% of individuals displaying some mental disorder did not use psychotropic drugs, which indicates an important gap between demand and access to treatment. A significant failure is evident in the health system for patients with mental disorders; this could be due to health workers' inability to recognize mental disorders among individuals.
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Affiliation(s)
- Maria Ines Quintana
- Federal University of São Paulo - Paulista Medical School, São Paulo, Brazil.
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Martin D, Cacozzi A, Macedo T, Andreoli SB. Significado da busca de tratamento por mulheres com transtorno depressivo atendidas em serviço de saúde público. INTERFACE-COMUNICACAO SAUDE EDUCACAO 2012. [DOI: 10.1590/s1414-32832012000400003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
O objetivo deste estudo de caráter etnográfico foi analisar o significado da busca de tratamento por mulheres com transtorno depressivo atendidas em um Núcleo de Atenção Psicossocial do município de Santos, São Paulo, Brasil. Foram identificados, neste contexto: o tratamento da depressão no serviço (do encaminhamento ao atendimento), as noções de doença elaboradas pelas mulheres e o consumo de medicamentos. Ficaram evidentes: a banalização da depressão, a importância do psiquiatra e do uso de antidepressivos e ansiolíticos no tratamento. Os padrões encontrados de consumo dos medicamentos pelas mulheres sugerem a ocorrência de uma "toxicomania medicamentosa". O uso de medicamentos, além da ação farmacológica, possui uma ação simbólica, no sentido de conforto e cuidado. O trabalho aponta para a necessidade de se articularem o significado das experiências das mulheres e as abordagens terapêuticas da depressão na construção das políticas públicas de saúde mental.
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Rubio-Valera M, Fernández A, Luciano JV, Hughes CM, Pinto-Meza A, Moreno-Küstner B, Palao DJ, Haro JM, Serrano-Blanco A. Psychotropic prescribing in Catalonia: results from an epidemiological study. Fam Pract 2012; 29:154-62. [PMID: 21926053 DOI: 10.1093/fampra/cmr078] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Mental disorders (MDs) are mainly treated in primary care (PC), where psychotropic drug (PSD) prescribing is highly prevalent. Prescription of PSD is associated with clinical and non-clinical factors. PURPOSE To describe the patterns of PSD prescribing over a 12-month period and to determine the factors associated with this in a PC population. METHODS Cross-sectional study. Data were collected on 3815 patients, via patient interview, on sociodemographics and MDs [Diagnostic and Statistical Manual of Mental Disorders (DSM-IV criteria)]. Computerized records provided data on PSD prescribing. Multilevel logistic regressions assessed the factors that influence prescribing. RESULTS Thirty-four per cent of PC patients were prescribed PSDs >12 months, with anxiolytics being the most commonly prescribed (22%). Fifty-three per cent of patients with any MD in this 12-month period were prescribed PSDs; however, 25% of patients without any of these disorders were also prescribed these medications. Higher rates of prescribing were associated with female gender, older age, presence of MD, being a househusband/housewife, consulting about psychological problems, increasing number of consultations and higher self-perceived disability. PSDs were less likely to be prescribed to patients born outside Spain and those consulting about physical conditions. PSD prescribing was higher in patients previously married and antipsychotic prescribing was higher in patients never married. No statistically significant associations were found between PSD prescription and education. CONCLUSIONS PSD prescribing rates are high in Catalonia and are associated with a number of clinical and non-clinical factors. A significant proportion of patients are receiving these drugs in the absence of MD. These findings need to be considered when prescribing in PC.
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Affiliation(s)
- Maria Rubio-Valera
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain.
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Kohrt BA, Worthman CM. Gender and anxiety in Nepal: the role of social support, stressful life events, and structural violence. CNS Neurosci Ther 2010; 15:237-48. [PMID: 19691543 DOI: 10.1111/j.1755-5949.2009.00096.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Throughout the world, anxiety disorders are 1.5-2 times more prevalent among women than men but the reasons for this gender disparity remain elusive. Despite frequent attribution to cultural roles of men and women, data regarding gendered risk factors in non-Western settings are scant. AIMS This study evaluated the role of gender as a moderator (effect modifier) of stressful life events (SLEs) and social support on the risk of anxiety in Nepal. A cross-sectional random sampling design was employed to recruit 316 persons in a rural community. The participants completed the Beck Anxiety Inventory (BAI), Stressful Life Events Rating Scale (SLERS), and a measure of social support. RESULTS The prevalence of anxiety differed by gender: 36.9% of women versus 20.4% of men endorsed anxiety symptoms above the validated cutoff for intervention (odds ratio [OR]= 2.3, 95% confidence interval [CI]= 1.4-3.8). The number of SLEs and levels of social support did not differ by gender, nor did gender moderate the relationship between SLEs and anxiety. Gender did moderate the relationship of social support with anxiety. Men who reported low social support had 3.5 times greater odds (95% CI = 1.4-10.7) of endorsing anxiety relative to men reporting high social support. Women exhibited no association of anxiety with social support. CONCLUSION Women are at a greater risk of anxiety in Nepal. Social support moderates the risk of anxiety among men but not among women. Ethnography and mixed-methods research are needed to identify other forms of support that may be protective for women and such factors should be promoted in gender-focused mental health interventions.
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Affiliation(s)
- Brandon A Kohrt
- Department of Anthropology, Emory University, Atlanta, GA 30322, USA.
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Rojas G, Fritsch R, Gaete J, González I, Araya R. Use of psychotropic medication in Santiago, Chile. J Ment Health 2009. [DOI: 10.1080/09638230500195221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Silva ATCD, Menezes PR. Burnout syndrome and common mental disorders among community-based health agents. Rev Saude Publica 2009; 42:921-9. [PMID: 18833390 DOI: 10.1590/s0034-89102008000500019] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2007] [Accepted: 04/02/2008] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To estimate the prevalence of the burnout syndrome and of common mental disorders among community-based health agents, also identifying associated factors. METHODS A cross-sectional survey was carried out in 2006 with 141 community-based health agents who had been working for at least six months in primary care units in the city of São Paulo (Southeastern Brazil). The participants answered three questionnaires: one about sociodemographic, health- and work-related characteristics, the Self Reporting Questionnaire, and the Maslach Burnout Inventory, which allows the assessment of three dimensions of the burnout syndrome: emotional exhaustion, depersonalization and reduced personal accomplishment. Multivariate logistic regression was used to examine associations between variables. RESULTS Overall, 24.1% of the interviewees presented burnout syndrome. Moderate or high levels of emotional exhaustion, depersonalization and reduced personal accomplishment were observed in 70.9%, 34.0% and 47.5% of the participants, respectively. The prevalence of common mental disorders was 43.3%. Positive correlations between the three dimensions of burnout, were observed. Presence of common mental disorder was independently associated with higher levels of emotional exhaustion and reduced personal accomplishment. CONCLUSIONS The high frequency of intense levels of burnout and the high prevalence of common mental disorders among community-based health agents point to the need of intervention strategies in these individuals' daily lives and of further studies to better understand the actual picture and the determinants of burnout.
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Gentil AF, de Mathis MA, Torresan RC, Diniz JB, Alvarenga P, do Rosário MC, Cordioli AV, Torres AR, Miguel EC. Alcohol use disorders in patients with obsessive-compulsive disorder: the importance of appropriate dual-diagnosis. Drug Alcohol Depend 2009; 100:173-7. [PMID: 19004577 DOI: 10.1016/j.drugalcdep.2008.09.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2008] [Revised: 09/18/2008] [Accepted: 09/20/2008] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the prevalence and clinical associated factors of alcohol use disorders (AUD) comorbidity in a large clinical sample of patients with obsessive-compulsive disorder (OCD). METHODS A cross-sectional study including 630 DSM-IV OCD patients from seven Brazilian university services, comparing patients with and without AUD comorbidity. The instruments of assessment used were a demographic and clinical questionnaire including evaluation of suicidal thoughts and acts and psychiatric treatment, the Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I), the Yale-Brown Obsessive-Compulsive Scale, the Dimensional Yale-Brown Obsessive-Compulsive Scale, the Brown Assessment of Beliefs Scale, the Beck Depression and Anxiety Inventories and the Clinical Global Impression Scale. Current or past alcohol and other psychoactive substances use, abuse and dependence were assessed using the SCID-I (section E) and corroborated by medical and familial history questionnaires. RESULTS Forty-seven patients (7.5%) presented AUD comorbidity. Compared to OCD patients without this comorbidity they were more likely to be men, to have received previous psychiatric treatment, to present lifetime suicidal thoughts and attempts and to have higher scores in the hoarding dimension. They also presented higher comorbidity with generalized anxiety and somatization disorders, and compulsive sexual behavior. Substance use was related to the appearance of the first O.C. symptoms and symptom amelioration. CONCLUSIONS Although uncommon among OCD treatment seeking samples, AUD comorbidity has specific clinical features, such as increased risk for suicidality, which deserve special attention from mental health professionals. Future studies focused on the development of specific interventions for these patients are warranted.
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Affiliation(s)
- André F Gentil
- Department & Institute of Psychiatry, Clinical Hospital, University of São Paulo Medical School, São Paulo, R. Dr. Ovidio Pires de Campos, 485, 3o andar, CEAPESQ, sala 7, CEP 05403-010, São Paulo, SP, Brazil.
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Lima MCP, Menezes PR, Carandina L, Cesar CLG, Barros MBDA, Goldbaum M. Transtornos mentais comuns e uso de psicofármacos: impacto das condições socioeconômicas. Rev Saude Publica 2008; 42:717-23. [DOI: 10.1590/s0034-89102008005000034] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2007] [Accepted: 04/22/2008] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: Avaliar a influência das condições socioeconômicas na associação entre transtornos mentais comuns, uso de serviços de saúde e de psicofármacos. MÉTODOS: Estudo transversal populacional conduzido na cidade de Botucatu, SP, com amostragem probabilística, estratificada e por conglomerados. Foram realizadas entrevistas domiciliares com 1.023 sujeitos de 15 anos ou mais de idade, entre 2001 e 2002. Transtorno mental comum foi avaliado utilizando o Self Reporting Questionnaire (SRQ-20). O uso de serviços foi investigado com relação à quinzena anterior à entrevista e uso de psicotrópicos, nos três dias anteriores. Utilizou-se regressão logística para análise multivariável, considerando o efeito do desenho. RESULTADOS: No total da amostra, 13,4% (IC 95%: 10,7;16,0) procuraram serviços de saúde na quinzena anterior à entrevista. A procura de serviços de saúde se associou ao sexo feminino (OR=2,0) e à presença de transtorno mental comum (OR=2,2). Na amostra 13,3% (IC 95%: 9,2;17,5) referiram ter usado ao menos um psicotrópico, destacando-se os antidepressivos (5,0%) e os benzodiazepínicos (3,1%). Na análise multivariável, sexo feminino e presença de transtorno mental comum mantiveram-se associados ao uso de benzodiazepínicos. Renda per capita mostrou-se direta e independentemente associada ao uso de psicofármacos, conforme aumento da renda. CONCLUSÕES: Menor renda associou-se à presença de transtorno mental comum, mas não ao uso de psicotrópicos. A associação entre transtorno mental comum e uso de psicotrópicos e maior renda reforça a hipótese da existência de iniqüidades no acesso à assistência médica na população estudada.
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Andrade LH, Viana MC, Tófoli LFF, Wang YP. Influence of psychiatric morbidity and sociodemographic determinants on use of service in a catchment area in the city of São Paulo, Brazil. Soc Psychiatry Psychiatr Epidemiol 2008; 43:45-53. [PMID: 17934683 DOI: 10.1007/s00127-007-0263-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2007] [Accepted: 09/10/2007] [Indexed: 11/25/2022]
Abstract
BACKGROUND Recent population-based studies in Latin American and the Caribbean (LAC) countries brought evidence of the growing burden of mental illness in this region. The objective of this study is to examine determinants of health service utilization by individuals with psychiatric disorders in a defined area in the city of São Paulo, Brazil. METHOD Data were derived from São Paulo Catchment Area Study (SP-ECA), a cross-sectional household prevalence survey, based on a representative adult sample (N=1,464) living in two defined boroughs. The psychiatric diagnosis was assessed through the CIDI 1.1 interview, yielding ICD-10 diagnoses. The past-month use of health services--for general medical (GM) care and mental health (MH) care sectors--was investigated in their relationship with sociodemographic features, insurance coverage, GM conditions, and psychiatric morbidity. RESULTS Nearly one-third (32.2%) of the total sample used health services in the last month: 29.0% attended GM care and 7.8% used MH care. Logistic regression models showed that being female, older than 60 years, having private insurance coverage, and presence of psychiatric morbidity increased the level GM care seeking in the total sample. For those with 12-month psychiatric disorders, the determinants for GM sector use were female gender, age 45-59 years old, and private insurance coverage, whereas separated, divorced, or widowed women had the highest odds (OR 9.9; 95% CI: 2.7-36.5) for using MH service. Low-income people were less likely to seek MH services. CONCLUSION The major contribution of this article is to underscore the impact of MH on health care systems, in a LAC country where service use information is scarce. The main finding is that inequalities in the access to MH care occurred, with low-income people having less likelihood of receiving treatment for their mental disorder. Access to health service in this catchment area reflected the great degree of deregulation and lack of integration. Additional efforts should address the barriers to the utilization of MH services in Brazil, including social inequities in the access to care.
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Affiliation(s)
- Laura Helena Andrade
- Section of Psychiatric Epidemiology, Institute and Dept. of Psychiatry, School of Medicine, University of São Paulo, São Paulo, SP, Brazil.
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Ribeiro CS, Azevedo RCS, Silva VFD, Botega NJ. Chronic use of diazepam in primary healthcare centers: user profile and usage pattern. SAO PAULO MED J 2007; 125:270-4. [PMID: 18094893 DOI: 10.1590/s1516-31802007000500004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2006] [Accepted: 09/20/2007] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE Chronic use of benzodiazepines is frequent in general practice. The aim of this study was to describe the usage pattern and profile of chronic users of diazepam who had been consuming this drug for a minimum of thirty-six months continuously. DESIGN AND SETTING This was a descriptive study (survey and clinical assessment) at five primary healthcare centers in Campinas, Brazil. METHODS Psychotropic drug control books revealed 48 eligible patients. Among these, 41 were assessed by means of the Schedule for Clinical Assessment in Neuropsychiatry (SCAN), the Hospital Anxiety and Depression scale (HAD) and a questionnaire on usage pattern. RESULTS Most patients were women (85.4%). The patients' mean age was 57.6 years, and they were from the social strata C (39%), D (54%) and E (7%). The mean length of diazepam consumption was 10 years. The patients presented a lack of prescription compliance and had made frustrated attempts to stop using the drug. 55.5% said their doctor had never given any guidance on the effects of the drug. According to SCAN, 25 patients (61%) suffered from depressive disorders; only 12 cases of benzodiazepine dependence were detected by this instrument. CONCLUSION There is a need to improve the detection and treatment of mental disorders, as well as to prevent inappropriate prescription and use of benzodiazepines. Diazepam dependence has distinctive characteristics that make it undetected by SCAN.
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Affiliation(s)
- Carmen Sylvia Ribeiro
- Department of Medical Psychiatry and Psychology, School of Medical Sciences, Universidade Estadual de Campinas, Campinas, São Paulo, Brazil
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Rodrigues MAP, Facchini LA, Lima MSD. Modificações nos padrões de consumo de psicofármacos em localidade do Sul do Brasil. Rev Saude Publica 2006; 40:107-14. [PMID: 16410990 DOI: 10.1590/s0034-89102006000100017] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Avaliar a prevalência e padrão de consumo de psicofármacos pela população e comparar esses resultados com outro estudo de 1994. MÉTODOS: Estudo transversal de base populacional, com 3.542 indivíduos de 15 anos ou mais, residentes na zona urbana de Pelotas em 2003. Os dados referentes ao consumo de duas semanas foram coletados em entrevistas domiciliares, utilizando um questionário idêntico ao utilizado em 1994. As variáveis estudadas foram: idade, sexo, cor da pele, situação conjugal, renda familiar, escolaridade, tabagismo, diagnóstico médico de hipertensão e consulta médica nos últimos três meses. Na análise bivariada, utilizou-se teste de qui-quadrado de Pearson e de tendência linear. A análise multivariada foi composta por quatro níveis. RESULTADOS: A prevalência de consumo de psicofármacos foi de 9,9% (IC 95%: 8,9-10,9). Ao comparar as prevalências padronizadas por idade, não houve diferença significativa em relação à prevalência observada em 1994. O maior consumo de psicofármacos associou-se significativamente a: ser do sexo feminino, o aumento da idade, o diagnóstico médico de hipertensão e a utilização de serviços médicos. Dos entrevistados, 74% dos usuários estavam utilizando psicofármacos há mais de três meses. CONCLUSÕES: Após uma década, a prevalência permanece alta, porém o consumo de psicofármacos não aumentou. Os achados sugerem a importância da indicação adequada dos psicofármacos e do acompanhamento médico regular desses usuários, dada a associação encontrada entre as consultas e o consumo.
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Affiliation(s)
- Maria Aparecida P Rodrigues
- Programa de Pós-Graduação em Epidemiologia, Faculdade de Medicina, Universidade Federal de Pelotas, Pelotas, RS, Brazil.
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Poyares D, Pinto LR, Tavares S, Barros-Vieira S. Hipnoindutores e insônia. BRAZILIAN JOURNAL OF PSYCHIATRY 2005; 27 Suppl 1:2-7. [PMID: 16082448 DOI: 10.1590/s1516-44462005000500002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
O objetivo deste artigo de atualização é o de descrever brevemente o perfil, a utilização clínica e a indicação de alguns dos sedativos e compostos hipnóticos mais utilizados. Cerca de 2/3 de todas as prescrições hipnóticas vão para o uso crônico. Os benzodiazepínicos estão entre as drogas mais prescritas mundialmente. As mulheres, os idosos e os pacientes psiquiátricos e clínicos estão entre os usuários crônicos de hipnóticos. O zolpidem é, atualmente, o hipnótico mais prescrito na maioria dos países. Parece ser mais seguro em comparação aos benzodiazepínicos e poderia ser uma opção para o uso de longo prazo e controlado ("quando necessário"). Os antidepressivos sedativos encontram-se também entre as medicações mais prescritas para sedação em pacientes com insônia nos EUA e no Reino Unido. São descritos efeito sedativo e uso de trazodona, mirtazapina, doxepina e amitriptilina. Os autores também discutem o uso de melatonina e suas propriedades sedativas e o uso racional de antipsicóticos sedativos para insônia crônica, em especial em pacientes psiquiátricos. Finalmente, alguns compostos fitoterápicos são mencionados.
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Affiliation(s)
- Dalva Poyares
- Centro para Estudos do Sono Instituto de Psiquiatria, Hospital das Clínicas, Universidade de São Paulo.
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Almeida-Filho N, Lessa I, Magalhães L, Araújo MJ, Aquino E, James SA, Kawachi I. Social inequality and depressive disorders in Bahia, Brazil: interactions of gender, ethnicity, and social class. Soc Sci Med 2004; 59:1339-53. [PMID: 15246165 DOI: 10.1016/j.socscimed.2003.11.037] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We conducted a study of the association between gender, race/ethnicity, and social class and prevalence of depressive disorders in an urban sample (N = 2302) in Bahia, Brazil. Individual mental health status was assessed by the PSAD/QMPA scale. Family SES and head of household's schooling and occupation were taken as components for a 4-level social class scale. Race/ethnicity (white, moreno, mulatto, black) was assessed with a combination of self-designation and a system of racial classification. The overall 12-month prevalence of depressive symptoms was 12%, with a female:male ratio of 2:1. Divorced/widowed persons showed the highest prevalence and single the lowest. There was a negative correlation with education: the ratio college educated:illiterate was 4:1. This gradient was stronger for women than men. There was no F:M difference in depression among Whites, upper-middle classes, college-educated, or illiterate. Prevalence ratios for single, widowed and Blacks were well above the overall pattern. Regarding race/ethnicity, higher prevalences of depression were concentrated in the Moreno and Mulatto subgroups. There was a consistent social class and gender interaction, along all race/ethnicity strata. Three-way interaction analyses found strong gender effect for poor and working-class groups, for all race/ethnicity strata but Whites. Black poor yielded the strongest gender effect of all (up to nine-fold). We conclude that even in a highly unequal context such as Bahia, Blacks, Mulattos and women were protected from depression by placement into the local dominant classes; and that the social meaning of ethnic-gender-generation diversity varies with being unemployed or underemployed, poor or miserable, urban or rural, migrant or non-migrant.
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Affiliation(s)
- Naomar Almeida-Filho
- Instituto de Saúde Coletiva at the Federal University of Bahia, Campus Canela, Salvador, Bahia 40210-070, Brazil.
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Nogueira-Martins LA, Fagnani Neto R, Macedo PCM, Cítero VA, Mari JJ. The mental health of graduate students at the Federal University of São Paulo: a preliminary report. Braz J Med Biol Res 2004; 37:1519-24. [PMID: 15448873 DOI: 10.1590/s0100-879x2004001000011] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We present data regarding the care provided to graduate level health professionals at the mental health center of the Federal University of São Paulo. From September 1996 to September 2003, 146 graduate students (99 in the Master's degree program and 47 in the Doctoral program) were attended. This population was predominantly female (68.5%), with a mean (+/- SD) age of 28.6 +/- 4.42 years, not married (71.9%). Most of the subjects were professionals who had not graduated from the Federal University (78.1%). The students who sought help for psychological and/or psychiatric problems were classified into two categories: situational-adaptive crises and psychopathological crises. The main diagnoses were depression and anxiety disorders (44%) causing 4.5% of the subjects to be temporarily suspended from their graduate studies; 19.2% reported that they had used psychotropic drugs within the previous month, and 47.9% referred to sleep disturbances. Suicidal tendencies were mentioned by 18% of those interviewed. Students with emotional disturbances and academic dysfunctions should be recognized at an early stage, and it is fundamental for them to have access to mental health programs that provide formal, structured and confidential care. Thus, it is important that professors and advisors in graduate programs build a warm and affective learning environment. If we consider the expressive growth in Brazilian scientific production resulting from the implementation of an extensive national system of graduate education, it is important to focus efforts on enhancing and upgrading the mental health care system.
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Affiliation(s)
- L A Nogueira-Martins
- Departamento de Psiquiatria, Universidade Federal de São Paulo, Rua Botucatu 740, 04023-900 São Paulo, SP, Brasil
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Duarte C, Hoven C, Berganza C, Bordin I, Bird H, Miranda CT. Child mental health in Latin America: present and future epidemiologic research. Int J Psychiatry Med 2004; 33:203-22. [PMID: 15089004 DOI: 10.2190/4wjb-bw16-2tge-565w] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This report reviews population studies of child and adolescent mental health carried out in Latin America over the past 15 years. Also considered is the issue of how to meet the needs of children and adolescents who may present mental health problems in Latin America, given that most of them live in poverty in economies that are underdeveloped, providing limited resources. METHOD Ten studies from six different countries were identified that employed some form of randomized sampling method and used standardized instruments for assessment. The authors present a summary of the main characteristics of these studies, highlighting methodological features that may account for differences in the rates obtained. RESULTS Overall, a similar pattern of prevalence and risk factors for mental health problems in children and adolescents in Latin American countries emerged. Moreover, rates of disorders in these children are similar to the 15 to 20% found in other countries. These findings are similar to those observed when adult mental health problems are considered. Prevention and treatment strategies are discussed and the peculiarities of the delivery of mental health services for children and adolescents are explored. CONCLUSIONS Future research needs to focus on understanding of resilience and formal and informal mental health delivery systems of care available in different Latin American countries. Such research has high potential for ameliorating the prevention and treatment of child and adolescent mental health problems in this region of the world.
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Affiliation(s)
- Cristiane Duarte
- Universidade Federal de São Paulo-Escola Paulista de Medicina, Brazil.
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Kapczinski F, Amaral OB, Madruga M, Quevedo J, Busnello JV, de Lima MS. Use and misuse of benzodiazepines in Brazil: a review. Subst Use Misuse 2001; 36:1053-69. [PMID: 11504152 DOI: 10.1081/ja-100104489] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Benzodiazepines are among the most prescribed and consumed medication groups in the world. Although benzodiazepines are used in the treatment of several psychiatric and non-psychiatric disorders, and are generally safe and well-tolerated, the potential for misuse and abuse is considerable. This makes the study and regulation of benzodiazepine prescription and consumption an item of concern in public health around the world. Most developed countries have consistent data of benzodiazepine sales and consumption; however, data from developing countries is scarce, making health policies on the use of benzodiazepines a much tougher issue in these countries. This article aims to review the epidemiology of benzodiazepine use in Brazil, as well as to analyze how legislation, physician misinformation and economic factors might contribute to making benzodiazepine abuse a problem in the country.
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Affiliation(s)
- F Kapczinski
- Unidade de Psicofarmacologia, Depto. de Psiquiatria, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
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Huf G, Lopes CD, Rozenfeld S. [Long-term benzodiazepine use in women at a daycare center for older people]. CAD SAUDE PUBLICA 2000; 16:351-62. [PMID: 10883034 DOI: 10.1590/s0102-311x2000000200006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
While experts recommend caution against long-term benzodiazepine use in the elderly, survey data suggests that the use of benzodiazepine increase with age. The patterns of benzodiazepine use and factors associated with long-term use in population at risk were studied with a standarlized questionnaire applied to 634 women over 60, who attended a daycare center for older people in Rio de Janeiro between May, 1992 and December, 1995. Prevalence of benzodiazepine use in the last 15 days was 21.3% (CI 95% 18.1-24.5), and prevalence of daily use for 12 or more months was 7.4% (CI 95% 5.4-9.4). In a multivaried analysis the amount of drugs being consumed displayed an important and progressive association with long-term benzodiazepine use, with OR = 2.77 (CI 95% 1.17-6.57) for those who take from four to six drugs, and OR = 7.62 (CI 95% 3.18-18.26) for those who take more than seven drugs. Insomnia (OR = 8.87 CI 95% 2.53-31.06) and chronic headache (OR = 3.53 CI 95% 1.82-6.89) have also been associated with this pattern of use.
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Affiliation(s)
- G Huf
- Coordenação de Fiscalização Sanitária, Secretaria de Estado de Saúde, Rio de Janeiro, RJ, 20030-142, Brasil.
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Escrivá Ferrairó R, Pérez Díez A, Lumbreras García C, Molina París J, Sanz Cuesta T, Corral Sánchez M. [Benzodiazepine prescription at a health center: prevalence, its use and user characteristics]. Aten Primaria 2000; 25:107-10. [PMID: 10736941 PMCID: PMC7675919 DOI: 10.1016/s0212-6567(00)78472-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/1999] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To find the prevalence of prescription of benzodiazepines (BDZ) in 1997 at a health centre (HC), and the characteristics of both their consumption and the takers. DESIGN Crossover, observational study. SETTING Primary care urban centre. PATIENTS From a total of 7356 patients over 14 with clinical records and belonging to four lists, a random sample stratified by lists was selected. INTERVENTION A form was used to gather social and demographic data, educational level, family context, linked pathologies, number of visits to HC per year, BDZ prescription and variables defining the kind of consumption. MAIN RESULTS The prevalence of BDZ prescription was 7.7% (CI, 6-10%). Consumption profile: 33% long BDZ, 31% intermediate and 33% short. 44% consumed BDZ occasionally or for less than 2 weeks, and 42% had been taking it for over a year. For 56% (95% CI, 40-70) their G.P. was the origin of the prescription. The reason for the prescription was not specified in 42% of cases. The variables which defined the profile of the consumers, included in the logistic regression, were: sex, number of visits and linked pathologies, whose OR were: 1.57 (CI, 1.08-2.03), 1.11 (CI, 1.06-1.17) and 1.61 (CI, 1.04-2.05). CONCLUSIONS The prevalence of BDZ prescription during 1997 in the population seen at our clinics was very similar to the figures found in other studies, with higher annual consumption averages and without the reason for taking it being specified in half the cases. The profile of BDZ takers was: mainly women, people with linked pathologies, and as a function of the number of attendances.
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Abstract
A formulação de políticas em saúde mental depende essencialmente de informações a respeito da freqüência e distribuição dos transtornos depressivos. Nos últimos 15 anos, pesquisas de base populacional em epidemiologia psiquiátrica têm sido conduzidas, gerando conhecimento detalhado sobre a freqüência, fatores de risco, incapacidade social, e uso de serviços de saúde. Neste artigo, dados sobre a epidemiologia da depressão são discutidos, a partir de resultados de recentes pesquisas populacionais: o estudo da Área de Captação Epidemiológica do Instituto Nacional de Saúde Mental dos Estados Unidos (ECA- NIMH), a Pesquisa Nacional de Co-morbidade (NCS), a pesquisa de Morbidade Psiquiátrica na Grã-Bretanha (OPCS), o Estudo Brasileiro Multicêntrico de Morbidade Psiquiátrica, e outras pesquisas conduzidas no Brasil em atenção primária. As prevalências de depressão maior e de distimia, bem como a de outros transtornos depressivos, são altas, independente do lugar onde a pesquisa foi conduzida, tipo de instrumento diagnóstico usado, e dos períodos de tempo para os quais a prevalência se aplica. Depressão é mais comum entre mulheres, pessoas divorciadas ou separadas, vivendo sozinhas, com baixo nível de escolaridade e renda, desempregados e morando em zonas urbanas. Pessoas deprimidas são mais sujeitas a consultarem médicos e a serem hospitalizadas. O custo e a eficácia dos tratamentos para depressão devem ser balanceados com o alto custo individual e social associados à enfermidade.
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Almeida-Filho N. Becoming modern after all these years: social change and mental health in Latin America. Cult Med Psychiatry 1998; 22:285-316. [PMID: 9833204 DOI: 10.1023/a:1005321431115] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This paper takes a critical standpoint, both theoretical and methodological, to revisit Inkeles and Smith's hypothesis on the association between modernization and mental health. First it is proposed a critical evaluation of the premises of the conceptual treatment of the relationships between social change and mental health prevailing during the past two decades. Secondly, results from epidemiologic research on the psychological outcomes of social development in Latin America are reviewed, emphasizing the methodological improvements which occurred during the past two decades. Selected findings of an epidemiological survey recently conducted in urban Brazil are then presented, focusing on a case-control analysis of the socio-economic correlates of individual mental health. Finally, some of the implications of the new evidence concerning the social change and mental health hypothesis are discussed, as an attempt to interpret these findings in the light of recent developments of theories on social change and health in the contemporary world.
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Affiliation(s)
- N Almeida-Filho
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Brazil
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31
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Tirol R, Menezes PR. Computerized psychiatric interviews: can they help to improve medical care? SAO PAULO MED J 1998; 116:1821-2. [PMID: 10030108 DOI: 10.1590/s1516-31801998000500007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Studies on psychiatric disorders in Brazil have shown high prevalence rates, both in the community and in primary care centers. However, psychiatric assessments carried out by interviewers have some inherent problems which influence inter-observer reliability. There is great potential for the use of computerized interviews. This article discusses some advantages of this kind of assessment, and indicates a need for investigation into its applicability to Brazilian health care settings.
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Affiliation(s)
- R Tirol
- Department of Preventive Medicine, Faculdade de Medicina da Universidade de São Paulo, Brazil
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de Lima MS, Béria JU, Tomasi E, Mari JJ. Use of amphetamine-like appetite suppressants: a cross-sectional survey in Southern Brazil. Subst Use Misuse 1998; 33:1711-9. [PMID: 9680089 DOI: 10.3109/10826089809058951] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In 1994 a cross-sectional survey was undertaken in Pelotas, Southern Brazil, to assess the prevalence of amphetamine-like appetite suppressant use. 1,277 adults were interviewed, and the prevalence of anorectic drug use was 1.3% (95% CI = 0.7-1.9): 15 women and one man, mainly from higher socioeconomic groups. Most of the users (81%) had a medical prescription. Forty-one different drugs had been prescribed. Mean length of use was 8.7 months. These findings are discussed in terms of the overreliance on anorectics as aids to dieting, the dangers of polypharmacy, and the risks of long-term use.
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Affiliation(s)
- M S de Lima
- Departamento de Saúde Mental, Universidade Federal de Pelotas, RS, Brazil
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Ohayon MM, Caulet M, Priest RG, Guilleminault C. Psychotropic medication consumption patterns in the UK general population. J Clin Epidemiol 1998; 51:273-83. [PMID: 9495693 DOI: 10.1016/s0895-4356(97)00238-2] [Citation(s) in RCA: 124] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The prevalence of psychotropic medication consumption was assessed in the UK by surveying a representative sample of 4972 non-institutionalized individuals 15 years of age or older (participation rate, 79.6%). A questionnaire was administered over the telephone with the help of the Sleep-Eval Expert System. Topics covered included: type and name of medication, indication, dosage, duration of intake, and medical specialty of prescriber. Also collected were data pertaining to sociodemographics, physical illnesses, and DSM-IV mental disorders. Overall, 3.5% [95% CI: 3-4] of the sample reported current use of psychotropic medication. Consumption was higher among women [4.6% (3.8-5.4)] than men [2.3% (1.7-2.9)], and among the elderly (> or = 65 years of age). The distribution of psychotropics was: hypnotics 1.5%, antidepressants 1.1%, and anxiolytics 0.8%. The median duration of psychotropic intake was 52 weeks. General practitioners were the most common prescribers of psychotropics (over 80% for each class of drug). Nearly half the antidepressant users were diagnosed by the system with a DSM-IV anxiety disorder, and one-fifth the anxiolytic users with a depressive disorder. A marked improvement in sleep quality was reported by half the subjects using a psychotropic for sleep-enhancing purposes. Psychotropic users were more likely than non-users to report episodes of memory loss, vertigo, or anomia. Psychotropic medication consumption is lower and patterns of psychotropic prescription differ in the UK compared with other European and North American countries. Results suggest that physicians may not be sufficiently trained to deal with the overlap between general practice and psychiatry.
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Affiliation(s)
- M M Ohayon
- Centre de Recherche Philippe Pinel de Montréal, Québec, Canada
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Santana VS, de Almeida Filho N, da Rocha CO, Matos AS. [Proxy informant reliability and bias in epidemiological research: analysis of a screening questionnaire for mental disorders]. Rev Saude Publica 1997; 31:556-65. [PMID: 9629710 DOI: 10.1590/s0034-89101997000700003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES To evaluate the reliability, magnitude and direction of the resulting bias in the application of a screening instrument for mental disorders by considering proxy informants in comparison to primary informants. METHODS Data are taken from a general morbidity community-based survey carried out in 520 randomly selected households of an industrial area of the Metropolitan Region of Salvador, the capital of Bahia state, Brazil. During the pilot phase, the first 70 families of the total sample were asked to participate in the evaluation of research instruments. The Questionnaire of Adult Psychiatric Morbidity, QAPM, consists of 44 questions about psychiatric symptoms widely used in Brazil. The husbands and wives of the selected families answered QAPM questions regarding themselves and their respective partners. One family refused to participate. The Kappa index was estimated for each QAPM question. To assess the magnitude and direction of bias, the proportional variation of prevalence was estimated from proxy and primary respondents. Each informant was analyzed as a primary informant when answering about his/her own symptoms and as a proxy informant when answering those about his/her partner. RESULTS Proxy informants as compared to primary informants show weak reliability, as measured by the Kappa Index, particularly when husbands reported on their wives' symptoms. An overall underestimation of prevalence estimates was found, which reveals the potential negative bias with the use of proxy informants for psychological symptoms. No bias was found for only two questions (lack of appetite and globus hystericus) when women were taken as proxy informants for their husbands. In addition, departures of proxy informants from primary informant-based estimates were greater among men than to women. CONCLUSIONS Proxy informants underestimate the occurrence of psychological symptoms in this community-based study. When the feasibility of a research project, based on the QAPM depends on the use of proxies, wives may be recommended as better informants than their husbands.
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Affiliation(s)
- V S Santana
- Instituto de Saúde Coletiva da Universidade Federal da Bahia, Salvador, Brasil.
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Harpham T, Blue I. Linking health policy and social policy in urban settings: the new development agenda. Trans R Soc Trop Med Hyg 1997; 91:497-8. [PMID: 9463652 DOI: 10.1016/s0035-9203(97)90001-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- T Harpham
- School of Urban Development and Policy, South Bank University, London, UK.
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Simon GE, VonKorff M, Barlow W, Pabiniak C, Wagner E. Predictors of chronic benzodiazepine use in a health maintenance organization sample. J Clin Epidemiol 1996; 49:1067-73. [PMID: 8780618 DOI: 10.1016/0895-4356(96)00139-4] [Citation(s) in RCA: 71] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
While expert recommendations caution against long-term benzodiazepine use in the elderly, survey data suggest increasing benzodiazepine use with age. Computerized pharmacy records of staff-model HMO were used to examine benzodiazepine prescribing. Six-month prevalence of benzodiazepine use (2.8%) and prevalence of continued use (0.7%) were lower than earlier reports. Prevalence was higher in women and increased steadily with age. Among 7012 patients beginning benzodiazepine treatment, duration of use increased with patient age, prescription by a psychiatrist (vs. primary care or medical/surgical specialist), use of higher-potency drugs (lorazepam, and alprazolem, clonazepam) and larger number of pills in the initial prescription. Individual physicians varied significantly in drug choice, initial prescription size, and likelihood of chronic use. Among 200 patients treated in primary care, the physician-recorded indication for prescription was anxiety or depression in 27%, insomnia in 20%, and pain symptoms in 38%. These findings indicate a gap between benzodiazepine efficacy research and current clinical practice.
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Affiliation(s)
- G E Simon
- Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle, Washington, USA
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Bustelo P, Mari J, Fernández C, Andreoli SB, Levav I. A tranquil city with a high tranquilliser intake. Lancet 1996; 347:1264-5. [PMID: 8622480 DOI: 10.1016/s0140-6736(96)90783-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Lima MS, Beria JU, Tomasi E, Conceicao AT, Mari JJ. Stressful life events and minor psychiatric disorders: an estimate of the population attributable fraction in a Brazilian community-based study. Int J Psychiatry Med 1996; 26:211-22. [PMID: 8877488 DOI: 10.2190/w4u4-tctx-164j-kmab] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE A population-based survey was conducted in Pelotas, southern Brazil, to assess the specific and the combined contribution of life events and socioeconomic factors on the overall prevalence of minor psychiatric disorders (MPD). METHODS The study covered a representative sample of the population aged fifteen years or older living in the urban area of the city. Using multi-stage sampling, a total of thirty census tracts and 600 households were selected. A standardized questionnaire assessed the presence of MPD (using the Self-Reporting Questionnaire-SRQ-20), the occurrence of life events (death of a relative, a relative with a chronic disease, loss of employment, divorce, migration, accident, and robbery/assault), and socioeconomic factors. RESULTS The prevalence of MPD was 22.7 percent (17.9% males and 26.5% females) and increased with age. Significant linear relationships with education and income were observed: the less education and income, the higher the prevalence of MPD. All life events, except migration and accident, were positively associated with MPD. People who experienced divorce in the last year had a prevalence of MPD three times higher than those who had not. The likelihood of MPD increased linearly with the number of life events. The highest proportion of Population Attributable Fraction for any life events was 24 percent. CONCLUSIONS These data suggest that life events can explain a substantial proportion of MPD and with socioeconomic factors may be related to the onset of MPD.
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Affiliation(s)
- M S Lima
- Universidade Federal de Pelotas, RS, Brazil
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