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Medeiros S, Coelho R, Millett C, Saraceni V, Coeli CM, Trajman A, Rasella D, Durovni B, Hone T. Racial inequalities in mental healthcare use and mortality: a cross-sectional analysis of 1.2 million low-income individuals in Rio de Janeiro, Brazil 2010-2016. BMJ Glob Health 2023; 8:e013327. [PMID: 38050408 PMCID: PMC10693873 DOI: 10.1136/bmjgh-2023-013327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 10/15/2023] [Indexed: 12/06/2023] Open
Abstract
INTRODUCTION Mental health inequalities across racial and ethnic groups are large and unjust in many countries, yet these inequalities remain under-researched, particularly in low-income and middle-income countries such as Brazil. This study investigates racial and socioeconomic inequalities in primary healthcare usage, hospitalisation and mortality for mental health disorders in Rio de Janeiro, Brazil. METHODS A cohort of 1.2 million low-income adults from Rio de Janeiro, Brazil with linked socioeconomic, demographic, healthcare use and mortality records was cross-sectionally analysed. Poisson regression models were used to investigate associations between self-defined race/colour and primary healthcare (PHC) usage, hospitalisation and mortality due to mental disorders, adjusting for socioeconomic factors. Interactions between race/colour and socioeconomic characteristics (sex, education level, income) explored if black and pardo (mixed race) individuals faced compounded risk of adverse mental health outcomes. RESULTS There were 272 532 PHC consultations, 10 970 hospitalisations and 259 deaths due to mental disorders between 2010 and 2016. After adjusting for a wide range of socioeconomic factors, the lowest PHC usage rates were observed in black (adjusted rate ratio (ARR): 0.64; 95% CI 0.60 to 0.68; compared with white) and pardo individuals (ARR: 0.87; 95% CI 0.83 to 0.92). Black individuals were more likely to die from mental disorders (ARR: 1.68; 95% CI 1.19 to 2.37; compared with white), as were those with lower educational attainment and household income. In interaction models, being black or pardo conferred additional disadvantage across mental health outcomes. The highest educated black (ARR: 0.56; 95% CI 0.47 to 0.66) and pardo (ARR: 0.75; 95% CI 0.66 to 0.87) individuals had lower rates of PHC usage for mental disorders compared with the least educated white individuals. Black individuals were 3.7 times (ARR: 3.67; 95% CI 1.29 to 10.42) more likely to die from mental disorders compared with white individuals with the same education level. CONCLUSION In low-income individuals in Rio de Janeiro, racial/colour inequalities in mental health outcomes were large and not fully explainable by socioeconomic status. Black and pardo Brazilians were consistently negatively affected, with lower PHC usage and worse mental health outcomes.
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Affiliation(s)
- Sophia Medeiros
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Rony Coelho
- Instituto de Estudos para Políticas de Saúde, São Paulo, Brazil
| | - Christopher Millett
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, NOVA University Lisbon, Lisboa, Portugal
| | - Valeria Saraceni
- Health Surveillance Branch, Secretaria Municipal de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Claudia Medina Coeli
- Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Anete Trajman
- Programa de Pós-graduação em Clínica Médica, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Davide Rasella
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
| | - Betina Durovni
- Centro de Estudos Estratégicos, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Thomas Hone
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
- Instituto de Estudos para Políticas de Saúde, São Paulo, Brazil
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Ceolin G, Antunes LDC, Moretti M, Rieger DK, Moreira JD. Vitamin D and depression in older adults: lessons learned from observational and clinical studies. Nutr Res Rev 2023; 36:259-280. [PMID: 35022097 DOI: 10.1017/s0954422422000026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Depression is a mental disorder triggered by the interaction of social, psychological and biological factors that have an important impact on an individual's life. Despite being a well-studied disease with several established forms of treatment, its prevalence is increasing, especially among older adults. New forms of treatment and prevention are encouraged, and some researchers have been discussing the effects of vitamin D (VitD) on depression; however, the exact mechanism by which VitD exerts its effects is not yet conclusive. In this study, we aimed to discuss the possible mechanisms underlying the association between VitD and depression in older adults. Therefore, we conducted a systematic search of databases for indexed articles published until 30 April 2021. The primary focus was on both observational studies documenting the association between VitD and depression/depressive symptoms, and clinical trials documenting the effects of VitD supplementation on depression/depressive symptoms, especially in older adults. Based on pre-clinical, clinical and observational studies, it is suggested that the maintenance of adequate VitD concentrations is an important issue, especially in older adults, which are a risk population for both VitD deficiency and depression. Nevertheless, it is necessary to carry out more studies using longitudinal approaches in low- and middle-income countries to develop a strong source of evidence to formulate guidelines and interventions.
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Affiliation(s)
- Gilciane Ceolin
- Postgraduate Program in Nutrition, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil
- Translational Nutritional Neuroscience working Group, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Luciana da Conceição Antunes
- Department of Nutrition, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil
- Translational Nutritional Neuroscience working Group, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Morgana Moretti
- Postgraduate Program in Biochemistry, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Débora Kurrle Rieger
- Department of Nutrition, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil
- Translational Nutritional Neuroscience working Group, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Júlia Dubois Moreira
- Department of Nutrition, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil
- Translational Nutritional Neuroscience working Group, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil
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Constante HM, Bastos JL, Ruiz MA. The more you need, the less you get: Intersectionality and the inverse care law in the Brazilian depression care cascade. ETHNICITY & HEALTH 2023; 28:488-502. [PMID: 35608907 DOI: 10.1080/13557858.2022.2078483] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Substantial research has shown that the population distribution of major depressive disorder (MDD) is strongly influenced by race, gender, and socioeconomic position. However, a deeper understanding of inequities in access to care for MDD according to these social markers is yet to be reached. We use data from the 2019 Brazilian National Health Survey, which includes 87,187 respondents aged 18 years and over, to test two hypotheses derived from the inverse care law: women, Black, and low-education respondents have higher frequencies of MDD, but lower access to each step of the depression care cascade, including diagnosis by a health professional, regular healthcare visits, and access to specialised treatment (H1); low-education Black women show the highest MDD frequency and the lowest access to care across the entire cascade (H2). Partially supporting H1 and H2, our results reveal a bottleneck in the first step of the depression care cascade. While no racial inequities were observed in the MDD prevalence, Black individuals were less likely than whites to be diagnosed by a health professional (OR 0.74). Women (OR 2.64) and low-education (OR 1.18) were more likely to have probable MDD in relation to men and high-education respondents, respectively, but only women (OR 1.58) were more likely to be diagnosed. Low-education Black women were equally more likely to have probable MDD (OR 3.11) than high-education white men. Conversely, high-education white women emerged as the most likely to be diagnosed with MDD (OR 1.63). Our findings suggest the inverse care law applies to the depression care cascade in Brazil through indication that its healthcare system perpetuates a multilayered system of oppression that overlooks multiply marginalised individuals. We also show that adequate screening by health care professionals should mitigate the complex patterns of inequity revealed by our study.
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Affiliation(s)
- Helena M Constante
- Graduate Program in Public Health, Federal University of Santa Catarina, Campus Universitário Trindade, Florianópolis, Brazil
| | - João L Bastos
- Graduate Program in Public Health, Federal University of Santa Catarina, Campus Universitário Trindade, Florianópolis, Brazil
| | - Milagros A Ruiz
- Research Department of Epidemiology and Public Health, University College London, London, United Kingdom
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de Araújo TM, de Torrenté MDON. Mental Health in Brazil: challenges for building care policies and monitoring determinants. EPIDEMIOLOGIA E SERVIÇOS DE SAÚDE 2023; 32:e2023098. [PMID: 37075344 PMCID: PMC10108831 DOI: 10.1590/s2237-96222023000200028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Affiliation(s)
- Tânia Maria de Araújo
- Universidade Estadual de Feira de Santana, Núcleo de Epidemiologia, Feira de Santana, BA, Brazil
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Melo APS, Bonadiman CSC, Andrade FMD, Pinheiro PC, Malta DC. Depression Screening in a population-based study: Brazilian National Health Survey 2019. CIENCIA & SAUDE COLETIVA 2023; 28:1163-1174. [PMID: 37042897 DOI: 10.1590/1413-81232023284.14912022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 09/23/2022] [Indexed: 04/13/2023] Open
Abstract
This study evaluated the prevalence of positive screening for depression in Brazil and its associated factors. We used data from National Health Survey 2019 (Pesquisa Nacional de Saúde - PNS), a population-based survey with 88,531 adults. The Patient Health Questionnaire (PHQ-9) was used with two scoring methods, the algorithm and the cutoff point≥10. The variables included sociodemographic characteristics. The prevalence ratios and 95% confidence intervals (95%CI) were estimated using Poisson regression. The positive screening for depression was 10.8% (95%CI: 10.4-11.0), at the cutoff point ≥10 and 5.7% (95%CI: 5.4-6.0) for algorithm. Significant differences were found in prevalence in some Brazilian states. Multivariable analyses showed that being female, black, under 70 years of age, having little education, being single, and living in an urban area were independently associated with a depressive symptoms. The highest association was found in the states of Sergipe, Goiás, Piauí, Espírito Santo, São Paulo, Alagoas and lowest in Pará, Mato Grosso and Maranhão. The prevalence of positive screening for depression in Brazil has increased in recent years. More investment in mental health resources is necessary and surveys such as the PNS should be continued.
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Affiliation(s)
- Ana Paula Souto Melo
- Faculdade de Medicina, Universidade Federal de São João Del-Rei. Av. Sebastião Gonçalves Coelho 400, Sala 209A, Chanadour. 35501-296 Divinópolis MG Brasil.
- Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG). Belo Horizonte MG Brasil
| | | | - Fabiana Martins de Andrade
- Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG). Belo Horizonte MG Brasil
| | - Pedro Cisalpino Pinheiro
- Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG). Belo Horizonte MG Brasil
| | - Deborah Carvalho Malta
- Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG). Belo Horizonte MG Brasil
- Faculdade de Enfermagem, UFMG. Belo Horizonte MG Brasil
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Scotti Requena S, Alves Assumpção T, Mesquita Peres CH, Vidotto Cerqueira A, Loch AA, Li W, Reavley NJ. Cultural adaptation of the mental health first aid guidelines for depression in Brazil: a Delphi expert consensus study. BMC Psychiatry 2023; 23:76. [PMID: 36707802 PMCID: PMC9881332 DOI: 10.1186/s12888-023-04566-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 01/24/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Depression is a significant contributor to disability in Brazil, with most Brazilians affected by depression receiving no treatment. As the community, including family and friends, plays a crucial role in providing support for someone with depression, it is important that evidence-based resources are available to support people who wish to help. The aim of this study was to culturally adapt the English-language mental health first aid guidelines for assisting a person with depression for the Brazilian culture. METHODS A Delphi expert consensus study was conducted, with two expert panels; health professionals (n = 29) and people with lived experience of depression (n = 28). One hundred and seventy-four statements from the English-language guidelines were translated into Brazilian Portuguese and administered as a survey. Participants were asked to rate statements based on how appropriate those statements were for the Brazilian culture and to suggest new statements if appropriate. RESULTS Data were collected over two survey rounds. Consensus was achieved on 143 statements. A total of 133 statements were adopted from the English-language guidelines, whereas 10 new endorsed statements were generated from suggestions of the two expert panels. CONCLUSIONS There were similarities between the English-language and Brazilian guidelines, mainly related to family involvement and the value of empathy. More research on dissemination and incorporation of the guidelines into the Mental Health First Aid (MHFA) training course for Brazil is required.
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Affiliation(s)
- Simone Scotti Requena
- grid.1008.90000 0001 2179 088XCentre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Thais Alves Assumpção
- grid.11899.380000 0004 1937 0722Laboratorio de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Carlos Henrique Mesquita Peres
- grid.11899.380000 0004 1937 0722Laboratorio de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Amanda Vidotto Cerqueira
- grid.11899.380000 0004 1937 0722Laboratorio de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Alexandre Andrade Loch
- grid.11899.380000 0004 1937 0722Laboratorio de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil ,grid.450640.30000 0001 2189 2026Instituto Nacional de Biomarcadores em Neuropsiquiatria (InBion), Conselho Nacional de Desenvolvimento Cientifico e Tecnologico, São Paulo, Brazil
| | - Wenging Li
- grid.1008.90000 0001 2179 088XCentre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Nicola J. Reavley
- grid.1008.90000 0001 2179 088XCentre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
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Felipe LRR, Barbosa KSS, Virtuoso Junior JS. Sintomatologia depressiva e mortalidade em idosos da América Latina: uma revisão sistemática com metanálise. Rev Panam Salud Publica 2022; 46:e205. [PMCID: PMC9733709 DOI: 10.26633/rpsp.2022.205] [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: 12/02/2021] [Revised: 04/11/2022] [Indexed: 12/13/2022] Open
Abstract
Objetivo.
Averiguar a associação entre sintomatologia depressiva e mortalidade em idosos da América Latina.
Métodos.
Realizou-se uma revisão sistemática com metanálise de estudos indexados nas bases PubMed, Scientific Electronic Library Online (SciELO), Web of Science, Cochrane Library, Scopus e Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS). O estudo foi registrado na base PROSPERO (International Prospective Register of Systematic Reviews) e estruturado de acordo com o referencial metodológico PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). A metanálise foi realizada usando modelos de efeitos aleatórios, e os dados analisados incluíram as medidas de risco relativo (RR) bruto e heterogeneidade, com estimativas pontuais e intervalos de confiança de 95% (IC95%).
Resultados.
Cinco estudos, realizados no Brasil e no México, foram incluídos na metanálise, abrangendo 8 954 idosos. O RR para mortalidade na presença de sintomatologia depressiva foi de 1,44 (IC95%: 1,16; 1,78). A heterogeneidade encontrada foi de 80,87%. As metarregressões mostraram que quanto maior a proporção de mulheres nas amostras dos estudos, maior o risco de mortalidade associada à sintomatologia depressiva, e quanto maior o tempo de acompanhamento do estudo, menor o risco de mortalidade associada à sintomatologia depressiva.
Conclusão.
A presença de sintomatologia depressiva associou-se positivamente à mortalidade em idosos latino-americanos, com RR de óbito 44% maior em relação aos idosos sem sintomatologia depressiva. As principais limitações do estudo foram o pequeno número de trabalhos encontrados na revisão sistemática e a variação entre as escalas utilizadas para determinar a presença de sintomatologia depressiva.
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Affiliation(s)
| | | | - Jair Sindra Virtuoso Junior
- Universidade Federal do Triângulo Mineiro (UFTM), Programa de Pós-Graduação em Atenção à Saúde, Uberaba (MG), Brasil
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Craig A, Rochat T, Naicker SN, Mapanga W, Mtintsilana A, Dlamini SN, Ware LJ, Du Toit J, Draper CE, Richter L, Norris SA. The prevalence of probable depression and probable anxiety, and associations with adverse childhood experiences and socio-demographics: A national survey in South Africa. Front Public Health 2022; 10:986531. [PMID: 36388391 PMCID: PMC9650309 DOI: 10.3389/fpubh.2022.986531] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 10/10/2022] [Indexed: 01/26/2023] Open
Abstract
Objective and methods Mental health problems among adults are a growing public health concern, and middle-income countries such as South Africa are disproportionally affected. Using a large scale nationally representative weighted survey, we assessed the prevalence of probable depression, probable anxiety, and adverse childhood experiences (ACEs), and explored associations between probable depression, probable anxiety, ACEs, socio-economic status, and demographic characteristics. Results Nationally, 25.7, 17.8, and 23.6% of respondents, respectively, reported scores of ≥10 on the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7), indicating probable depression or probable anxiety, and an ACE score of ≥4 (high exposure). Overall probable depression prevalence across South Africa varied from 14.7 to 38.8%. Both probable depression and probable anxiety were more frequently reported among adults who were: retired and older (>65 years of age), and widowed, divorced, or separated; living in metropolitan areas; and only had primary school education. In a multivariable adjusted logistic regression, the likelihood of reporting probable depression or probable anxiety was also found to increase with each standard deviation increase in the ACE score (p < 0.001), independent of other socio-demographic determinants. Conclusion The prevalence of probable depression among respondents in South Africa varies significantly across the nine provinces. Furthermore, higher ACE score and several socio-demographic determinants were associated with a higher likelihood of probable depression and probable anxiety. Adult mental health services are urgently needed to identify groups of the population vulnerable to mental health problems for better targeting of interventions. Given the range of probable depression prevalence across the country, provincial level plans and resources should also reflect the burden of mental health problems in that province.
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Affiliation(s)
- Ashleigh Craig
- South African Medical Research Council/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tamsen Rochat
- Department of Science and Innovation-National Research Foundation Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Sara N. Naicker
- Department of Science and Innovation-National Research Foundation Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Witness Mapanga
- South African Medical Research Council/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Noncommunicable Disease Research Division, Wits Health Consortium (PTY) Ltd., Johannesburg, South Africa
| | - Asanda Mtintsilana
- South African Medical Research Council/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Siphiwe N. Dlamini
- South African Medical Research Council/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lisa J. Ware
- South African Medical Research Council/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Innovation-National Research Foundation Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Justin Du Toit
- Department of Science and Innovation-National Research Foundation Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Catherine E. Draper
- South African Medical Research Council/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Linda Richter
- Department of Science and Innovation-National Research Foundation Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Shane A. Norris
- South African Medical Research Council/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Human Development and Health, University of Southampton, Southampton, United Kingdom
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Mrejen M, Hone T, Rocha R. Socioeconomic and racial/ethnic inequalities in depression prevalence and the treatment gap in Brazil: A decomposition analysis. SSM Popul Health 2022; 20:101266. [PMID: 36281244 PMCID: PMC9587003 DOI: 10.1016/j.ssmph.2022.101266] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 09/09/2022] [Accepted: 10/10/2022] [Indexed: 11/05/2022] Open
Abstract
Depression is a major global health burden and there are stark socioeconomic inequalities in both the prevalence of depression and access to treatment for depression. In Brazil, racial/ethnic inequalities are of particular concern, but the factors contributing to these inequalities remain mostly unknown. This paper firstly explores determinants of depression and the treatment gap (i.e., untreated afflicted individuals) in Brazil and identifies if socio-economic and health system factors explain changes over time. Secondly, it analyses income and racial/ethnic inequalities in depression and the treatment gap and identifies factors explaining inequalities through decomposition methods. Data from two waves (2013 and 2019) of a representative household-based survey are used. In 2019, 10.8% of adults were depressed, but over 70% of depressed adults did not receive care. Black or brown/mixed Brazilians were more likely to have untreated depression, and region of residence was the most important determinant of these racial/ethnic inequalities. Notably, 44.6% of the difference in the treatment gap between white individuals and black and brown/mixed individuals was not explained by differences in observables, which could potentially be due to discrimination or difficulties in accessing treatment due to other non-observable characteristics. Employment, age, exposure to violence and physical activity are the main contributing factors to income inequalities in depression. These results suggest that policies aimed at improving the levels of exposure of lower-income individuals to risk factors may positively impact mental health and mental health inequalities, while addressing inequalities in service provision and resourcing for mental health and tackling barriers to access stemming from discrimination are essential to bridge the treatment gap equitably. In 2019, 10.8% of adults were depressed, but over 70% of depressed adults did not receive care. Lower income individuals were more likely to have depression. Black or brown/mixed individuals were more likely to have untreated depression. Region of residence was the most important determinant of racial/ethnic inequalities in the treatment gap. Exposure to violence and physical activity are relevant contributing factors to income inequalities in depression.
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Affiliation(s)
- Matías Mrejen
- Instituto de Estudos para Políticas de Saúde, São Paulo, Brazil,Corresponding author.
| | - Thomas Hone
- Public Health Policy Evaluation Unit, Imperial College London, London, UK
| | - Rudi Rocha
- São Paulo School of Business Administration (FGV EAESP) & Instituto de Estudos para Políticas de Saúde, São Paulo, Brazil
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Aliberti MJR, Suemoto CK. Empowering older adults and their communities to cope with depression in resource-limited settings. THE LANCET. HEALTHY LONGEVITY 2022; 3:e643-e644. [PMID: 36202121 DOI: 10.1016/s2666-7568(22)00216-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/07/2022] Open
Affiliation(s)
- Márlon Juliano Romero Aliberti
- Laboratorio de Investigacao Medica em Envelhecimento, Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-000, Brazil.
| | - Claudia Kimie Suemoto
- Laboratorio de Investigacao Medica em Envelhecimento, Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-000, Brazil; Research Institute, Hospital Sirio-Libanes, São Paulo, Brazil
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11
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Scazufca M, Nakamura CA, Seward N, Moreno-Agostino D, van de Ven P, Hollingworth W, Peters TJ, Araya R. A task-shared, collaborative care psychosocial intervention for improving depressive symptomatology among older adults in a socioeconomically deprived area of Brazil (PROACTIVE): a pragmatic, two-arm, parallel-group, cluster-randomised controlled trial. THE LANCET. HEALTHY LONGEVITY 2022; 3:e690-e702. [PMID: 36202129 PMCID: PMC9529612 DOI: 10.1016/s2666-7568(22)00194-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 08/05/2022] [Accepted: 08/09/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND There is an urgent need to reduce the burden of depression among older adults in low-income and middle-income countries (LMICs). We aimed to evaluate the efficacy of a task-shared, collaborative care psychosocial intervention for improving recovery from depression in older adults in Brazil. METHODS PROACTIVE was a pragmatic, two-arm, parallel-group, cluster-randomised controlled trial conducted in Guarulhos, Brazil. Primary care clinics (clusters) were stratified by educational level and randomly allocated (1:1) to either enhanced usual care alone (control group) or to enhanced usual care plus the psychosocial intervention (intervention group), which involved a 17-week psychosocial programme based on psychoeducation and behavioural activation approaches. Individuals approached for the initial screening assessment were selected randomly from a list of individuals provided by the Health Secretariat of Guarulhos. Face-to-face baseline assessments were conducted among adults aged 60 years or older registered with one of the primary care clinics and identified with clinically significant depressive symptomatology (9-item Patient Health Questionnaire [PHQ-9] score ≥10). Community health workers delivered the programme through home sessions, supported by a dedicated tablet application. Masking of clinic staff and community health workers who delivered the intervention was not feasible; however, research assistants conducting recruitment and follow-up assessments were masked to trial allocation. The primary outcome was recovery from depression (PHQ-9 score <10) at 8-month follow-up. All primary analyses were performed by intention to treat with imputed data. Adaptations to the protocol were made due to the COVID-19 pandemic; recruitment and intervention home sessions were stopped, and follow-up assessments were conducted by telephone. This trial is registered with the ISRCTN registry, ISRCTN57805470. FINDINGS We identified 24 primary care clinics in Guarulhos that were willing to participate, of which 20 were randomly allocated to either the control group (ten [50%] clusters) or to the intervention group (ten [50%] clusters). The four remaining eligible clusters were kept as reserves. Between May 23, 2019, and Feb 21, 2020, 8146 individuals were assessed for eligibility, of whom 715 (8·8%) participants were recruited: 355 (49·7%) in the control group and 360 (50·3%) in the intervention group. 284 (80·0%) participants in the control group and 253 (70·3%) in the intervention group completed follow-up at 8 months. At 8-month follow-up, 158 (62·5%) participants in the intervention group showed recovery from depression (PHQ-9 score <10) compared with 125 (44·0%) in the control group (adjusted odds ratio 2·16 [95% CI 1·47-3·18]; p<0·0001). These findings were maintained in the complete case analysis. No adverse events related to the intervention were observed. INTERPRETATION Although the COVID-19 pandemic altered delivery of the intervention, the low-intensity psychosocial intervention delivered mainly by non-mental health professionals was highly efficacious in improving recovery from depression in older adults in Brazil. Our results support a low-resource intervention that could be useful to reduce the treatment gap for depression among older people in other LMICs. FUNDING São Paulo Research Foundation and Joint Global Health Trials (UK Department for International Development, Medical Research Council, and the Wellcome Trust).
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Affiliation(s)
- Marcia Scazufca
- Instituto de Psiquiatria, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil; Departamento de Psiquiatria, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Carina A Nakamura
- Departamento de Psiquiatria, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Nadine Seward
- Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Darío Moreno-Agostino
- Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; ESRC Centre for Society and Mental Health, King's College London, London, UK; Centre for Longitudinal Studies, Social Research Institute, University College London, London, UK
| | - Pepijn van de Ven
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - William Hollingworth
- Health Economics Bristol, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Tim J Peters
- Bristol Dental School, University of Bristol, Bristol, UK
| | - Ricardo Araya
- Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
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Mulalint T, Seeherunwong A, Wanitkun N, Tongsai S. Determinants of continuing mental health service use among older persons diagnosed with depressive disorders in general hospitals: latent class analysis and GEE. BMC Health Serv Res 2022; 22:899. [PMID: 35818042 PMCID: PMC9275052 DOI: 10.1186/s12913-022-08250-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/23/2022] [Indexed: 11/10/2022] Open
Abstract
Background Prevalence of depression in older persons was a leading cause of disability. This group has the lowest access to service and retention in care compared to other age groups. This study aimed to explore continuing mental health service use and examined the predictive power of the mental health service delivery system and individual factors on mental health service use among older persons diagnosed with depressive disorders. Methods We employed an analytic cross-sectional study design of individual and organizational variables in 12 general hospitals selected using multi-stratified sampling. There were 3 clusters comprising community hospitals, advanced and standard hospitals, and university hospitals. Participants in each group were 150 persons selected by purposive sampling. We included older persons with a first or recurring diagnosis of a depressive disorder in the last 6 to 12 months of the data collection date. Data at the individual level included socio-demographic characteristics, Charlson Comorbidity Index, Attitude toward Depression and its treatment, and perceived social support. Data at the organizational level had hospital level, nurse competency, nurse-patient ratio, and appointment reminders. Descriptive statistics, Pearson chi-square test, latent class analysis (LCA), and marginal logistic regression model using generalized estimating equation (GEE) were used to analyze the data. Results The continuing mental health service use among older persons diagnosed with depressive disorders was 54%. The latent class analysis of four variables in the mental health services delivery organization yielded distinct and interpretable findings in two groups: high and low resource organization. The marginal logistic multivariable regression model using GEE found that organizational group and attitude toward depression and its treatment were significantly associated with mental health service use (p-value = 0.046; p-value = 0.003). Conclusions The findings suggest that improving continuing mental health services use in older persons diagnosed with depressive disorders should emphasize specialty resources of the mental health services delivery system and attitude toward depression and its treatment.
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Affiliation(s)
- Thida Mulalint
- D.N.S. Candidate, Faculty of Nursing, Mahidol University, Bangkok, Thailand
| | - Acharaporn Seeherunwong
- Department of Mental Health and Psychiatric Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand.
| | - Napaporn Wanitkun
- Department of Surgical Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand
| | - Sasima Tongsai
- Office for Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Brito VCDA, Bello-Corassa R, Stopa SR, Sardinha LMV, Dahl CM, Viana MC. Prevalence of self-reported depression in Brazil: National Health Survey 2019 and 2013. EPIDEMIOLOGIA E SERVIÇOS DE SAÚDE 2022; 31:e2021384. [PMID: 35830090 PMCID: PMC9897827 DOI: 10.1590/ss2237-9622202200006.especial] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 10/19/2021] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To describe the prevalence of self-reported depression among Brazilian adults in the 2019 National Health Survey (PNS) and compare to the 2013 PNS. METHODS Cross-sectional study of Brazilian adults using data from the 2019 and 2013 PNS. Prevalence and 95% confidence intervals (95%CI) of self-reported depression were estimated by region and demographic characteristics. Bivariate analyses were conducted using chi-squared tests. RESULTS There were 90,846 participants aged ≥ 18 years in 2019, and 60,202 in 2013. Between 2013 and 2019, prevalence of self-reported depression increased from 7.6% (95%CI 7.2;8.1) to 10.2% (95%CI 9.9;10.6) and of individuals who sought healthcare, from 46.4% (95%CI 43.8;49.1) to 52.8% (95%CI 50.7;55.0). Private clinics were the main source of healthcare. CONCLUSION Depression is highly prevalent in Brazil. Prevalence of diagnosis of depression and use of health services increased in the studied period. The predominance of care in private clinics suggests inequalities in the improvement of mental healthcare coverage.
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Affiliation(s)
| | - Rafael Bello-Corassa
- Ministério da Saúde, Departamento de Análise em Saúde e Vigilância
de Doenças Não Transmissíveis, Brasília, DF, Brazil
| | - Sheila Rizzato Stopa
- Ministério da Saúde, Departamento de Análise em Saúde e Vigilância
de Doenças Não Transmissíveis, Brasília, DF, Brazil
| | | | | | - Maria Carmen Viana
- Universidade Federal do Espírito Santo, Programa de Pós-Graduação em
Saúde Coletiva, Vitória, ES, Brazil
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14
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Lopes CDS, Gomes NL, Junger WL, Menezes PR. Trend in the prevalence of depressive symptoms in Brazil: results from the Brazilian National Health Survey 2013 and 2019. CAD SAUDE PUBLICA 2022; 38Suppl 1:e00123421. [PMID: 35544918 DOI: 10.1590/0102-311x00123421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 09/24/2021] [Indexed: 11/21/2022] Open
Abstract
This study aims to evaluate national variation in depression prevalence and in different sociodemographic groups, health behaviors, and macroregions of Brazil from 2013 to 2019. Data were obtained from two nationwide Brazilian surveys - Brazilian National Health Survey 2013 and 2019. Participants aged 18 years or older were included, totaling 60,202 individuals in 2013 and 88,531 in 2019. Depression was evaluated with the Patient Health Questionnaire-9 (PHQ-9). All estimations accounted for the population weights and the complex sampling. The findings showed that during the six years between the two surveys, the prevalence of depression in Brazil increased by 36.7%, going from 7.9% in 2013 to 10.8% in 2019, and this increase is higher among unemployed young adults, aged 18 to 24 years, with the increase in the prevalence of depression almost tripled (3.7 in 2013 and 10.3 in 2019), an increase of 178.4%. Those dwelling in urban areas had a higher increase in the prevalence of depression in the six-year period (39.8%) when compared to residents in rural areas (20.2%). There was an increase in the prevalence of depression from 2013 to 2019 for the worst categories of the three health behaviors included in the study for both men and women: heavy drinking, smoking, and not exercising the recommended level of physical activity. Our results show a significant increase in the prevalence of depression over the six years between the two surveys, mainly among the younger and unemployed men. The country's economic recession during this period may explain these findings.
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Affiliation(s)
- Claudia de Souza Lopes
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Nayara Lopes Gomes
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Washington Leite Junger
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil
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Tiguman GMB, Silva MT, Galvão TF. Prevalence of depressive and anxiety symptoms and their relationship with life-threatening events, tobacco dependence and hazardous alcohol drinking: a population-based study in the Brazilian Amazon. J Affect Disord 2022; 298:224-231. [PMID: 34715191 DOI: 10.1016/j.jad.2021.10.059] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 09/26/2021] [Accepted: 10/23/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND The burden of mental health disorders is high and may be particularly alarming in developing countries. We assessed the prevalence of depressive and anxiety symptoms and their relationship with life-threatening events, tobacco dependence, and hazardous alcohol drinking in the Brazilian Amazon. METHODS Cross-sectional population-based study conducted in Manaus in 2019 with adults selected by probabilistic sampling. Depressive symptoms were measured by the PHQ-9 instrument (cut-off ≥9) and anxiety symptoms by the GAD-7 scale (cut-off ≥10). Prevalence ratios (PRs) of depressive and anxiety symptoms were calculated by Poisson regression with robust variance with 95% confidence intervals (CI) following a hierarchical model. Partial least squares structural equation modeling was used to investigate the relationship between the outcomes and risk behaviors. RESULTS Out of the 2,321 participants, 24.3% (95%CI 22.2-26.5%) had depressive and 21.6% (95%CI 19.6-23.7%) had anxiety symptoms. Depressive symptoms were more frequent in women (PR=1.32; 95%CI 1.08-1.61), lower social class (PR=1.59; 95%CI 1.11-2.27), life-threatening events (PR=2.66; 95%CI 2.00-3.54), tobacco dependence (PR=1.84; 95%CI 1.37-2.47), worse health statuses (p<0.001), and chronic diseases (PR=1.63; 95%CI 1.33-2.00), but were lower in older adults (p=0.014). Anxiety symptoms were higher in women (PR=1.74; 95%CI 1.42-2.14), lower educational levels (PR=2.19; 95%CI 1.38-3.47), evangelical individuals (PR=1.28; 95%CI 1.05-1.57), having no religion (PR=1.72; 95%CI 1.24-2.38), life-threatening events (PR=3.26; 95%CI 2.41-4.41), tobacco dependence (PR=1.53; 95%CI 1.09-2.16), worse health statuses (p<0.001), and chronic diseases (PR=1.77; 95%CI 1.40-2.25). Depressive symptoms, anxiety symptoms, and life-threatening events were directly correlated with one another, while tobacco dependence and hazardous alcohol drinking were significantly intercorrelated (p<0.05). LIMITATIONS Cross-sectional design limits the assessment of causality. Recall bias was possible as responses were self-reported. GAD-7 scale was not validated in the Brazilian population. CONCLUSION Nearly a quarter of the population had depressive symptoms and one-fifth presented anxiety symptoms, which were associated with socioeconomic, behavioral, and health-related factors. Implementation of social well-being policies is required to minimize the burden of mental health disorders in the Amazonian population.
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Affiliation(s)
| | - Marcus Tolentino Silva
- Post-Graduate Program of Pharmaceutical Sciences, University of Sorocaba, Sorocaba, São Paulo, Brazil
| | - Taís Freire Galvão
- Faculty of Pharmaceutical Sciences, State University of Campinas, Campinas, São Paulo, Brazil
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16
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Nakamura CA, Scazufca M, Peters TJ, Fajersztajn L, Van de Ven P, Hollingworth W, Araya R, Moreno-Agostino D. Depressive and subthreshold depressive symptomatology among older adults in a socioeconomically deprived area in Brazil. Int J Geriatr Psychiatry 2022; 37. [PMID: 34811807 DOI: 10.1002/gps.5665] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 11/21/2021] [Indexed: 11/08/2022]
Abstract
UNLABELLED Depressive and subthreshold depressive symptomatology are common but often neglected in older adults. OBJECTIVE This study aimed to assess rates of depressive and subthreshold depressive symptomatology, and the characteristics associated, among older adults living in a socioeconomically deprived area of Brazil. METHODS This study is part of the PROACTIVE cluster randomised controlled trial. 3356 adults aged 60+ years and registered in 20 primary health clinics were screened for depressive symptomatology with the Patient Health Questionnaire-9 (PHQ-9). Depressive status was classified according to the total PHQ-9 score and the presence of core depressive symptoms (depressed mood and anhedonia) as follows: no depressive symptomatology (PHQ-9 score 0-4, or 5-9 but with no core depressive symptom); subthreshold depressive symptomatology (PHQ-9 score 5-9 and at least one core depressive symptom); and depressive symptomatology (PHQ-9 score ≥ 10). Sociodemographic information and self-reported chronic conditions were collected. Relative risk ratios and 95% CIs were obtained using a multinomial regression model. RESULTS Depressive and subthreshold depressive symptomatology were present in 30% and 14% of the screened sample. Depressive symptomatology was associated with female gender, low socioeconomic conditions and presence of chronic conditions, whereas subthreshold depressive symptomatology was only associated with female gender and having hypertension. CONCLUSIONS Depressive and subthreshold depressive symptomatology is highly prevalent in this population registered with primary care clinics. Strategies managed by primary care non-mental health specialists can be a first step for improving this alarming and neglected situation among older adults.
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Affiliation(s)
- Carina Akemi Nakamura
- Departamento de Psiquiatria, LIM 23, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Marcia Scazufca
- Departamento de Psiquiatria, LIM 23, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Tim J Peters
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Lais Fajersztajn
- Laboratório de Poluição Ambiental, Departamento de Patologia, Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, Brazil
| | - Pepijn Van de Ven
- Health Research Institute, University of Limerick, Limerick, Ireland
| | | | - Ricardo Araya
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Darío Moreno-Agostino
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Centre for Longitudinal Studies, UCL Social Research Institute, University College London, London, UK.,ESRC Centre for Society and Mental Health, King's College London, London, UK
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17
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Torres NPB, Alvares-Teodoro J, Júnior AAG, Horizonte PDB, Acurcio FDA. Social and economic factors associated with antidepressant use: results of a national survey in primary care. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2021.100307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Harding D, Pitcairn CFM, Machado DB, De Araujo LFSC, Millett C, Hone T. Interpersonal violence and depression in Brazil: A cross-sectional analysis of the 2019 National Health Survey. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001207. [PMID: 36962903 PMCID: PMC10021715 DOI: 10.1371/journal.pgph.0001207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/09/2022] [Indexed: 12/03/2022]
Abstract
Depression and interpersonal violence are issues of increasing public health concern globally, especially in low-and-middle income countries. Despite the known relationship between interpersonal violence and an increased risk of depression, there is a need to further characterise the experience of depression in those who have experienced violence, to better develop screening and treatment interventions. A cross-sectional analysis was conducted on responses from the 2019 Brazilian National Health Survey. The prevalence of depression (both clinician-diagnosed, and Patient Health Questionnaire (PHQ-9) screened) were estimated by type of violence experienced in the preceding 12 months (none, physical violence, sexual violence, physical and sexual violence, or threat of violence). Logistic regression models assessed the associations between violence and depression after adjusting for socioeconomic and demographic factors. Of 88,531 respondents, 8.1% experienced any type of violence. Compared to those not experiencing violence, those who experienced any type of violence had a higher prevalence of clinician-diagnosed or PHQ-9-screened depression (e.g. the prevalence of clinician-diagnosed depression was 18.8% for those experiencing sexual violence compared to 9.5% for those not experiencing violence). Both undiagnosed and untreated depression were also more prevalent in those experiencing any type of violence. In logistic regression models, any experience of violence was associated with a higher odds of depression (e.g. aOR = 3.75 (95% CI: 3.06-4.59) for PHQ-9-detected depression). Experiencing violence was also associated with a higher likelihood of having depression which was undiagnosed (e.g. in those who experienced sexual violence: aOR of 3.20, 95% CI 1.81-5.67) or untreated (e.g. in those who experienced physical and sexual violence: aOR = 8.06, 95% CI 3.44-18.9). These findings highlight the need to consider screening for depression in those affected by violence, and to prioritise mental healthcare in communities affected by violence.
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Affiliation(s)
- Daniel Harding
- Department of Primary Care and Public Health, Public Health Policy Evaluation Unity, Imperial College London, London, United Kingdom
| | - Charlie F M Pitcairn
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Daiane Borges Machado
- Centre for Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Brazil
| | | | - Christopher Millett
- Department of Primary Care and Public Health, Public Health Policy Evaluation Unity, Imperial College London, London, United Kingdom
| | - Thomas Hone
- Department of Primary Care and Public Health, Public Health Policy Evaluation Unity, Imperial College London, London, United Kingdom
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Oliveira G, Schimith MD, Silva LMCD, Cezar-Vaz MR, Cabral FB, Silveira VDN, Jerke LC. Fatores de risco cardiovascular, saberes e práticas de cuidado de mulheres: possibilidade para rever hábitos. ESCOLA ANNA NERY 2022. [DOI: 10.1590/2177-9465-ean-2021-0281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Objetivo investigar fatores de risco para doenças cardiovasculares e compreender as práticas de cuidado de mulheres. Método paralelo convergente misto. A etapa quantitativa foi transversal descritiva com formulário abordando características demográficas, socioeconômicas, fatores de risco cardiovascular, hábitos de vida e saúde, participaram 289 mulheres e aplicou-se estatística descritiva. A etapa qualitativa foi fundamentada na pesquisa participativa, exploratória descritiva, mediante entrevista semiestruturada, técnica de criatividade e sensibilidade e narrativas, com 30 mulheres. Resultados identificaram-se fatores como sedentarismo (60,9%), uso do anticoncepcional (57,9%), estresse (60,6%), depressão (40,1%), obesidade (38,8%), hipertensão arterial (33,6%), consumo de bebida alcoólica (29,8%), cigarro (16,6%), dislipidemia (25,6%) e diabetes (10,0%). Quanto aos saberes e práticas de cuidado, as participantes mencionaram os fatores, porém algumas relataram realizar os cuidados, e outras não, mesmo reconhecendo os riscos. Assim, compartilharam a falta de tempo para realizar exercícios físicos, dificuldades para cuidar da alimentação e aderir ao tratamento anti-hipertensivo e, ainda, relataram sentirem-se estressadas. Conclusão e implicações para a prática identificaram-se fatores modificáveis e as mulheres possuíam conhecimento acerca destes, entretanto divergiam sobre os cuidados, demonstrando a importância de ações voltadas a essa população.
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Barbosa EL, Moreno AB, Van Duinkerken E, Lotufo P, Barreto SM, Giatti L, Nunes MA, Viana MC, Figueiredo R, Chor D, Griep RH. The association between diabetes mellitus and incidence of depressive episodes is different based on sex: insights from ELSA-Brasil. Ther Adv Endocrinol Metab 2022; 13:20420188221093212. [PMID: 35464879 PMCID: PMC9019382 DOI: 10.1177/20420188221093212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 03/23/2022] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To investigate the association between diabetes mellitus (DM) and incidence of depressive episodes among men and women. METHODS Data were used from 12,730 participants (5866 men and 6864 women) at baseline (2008-2010) and follow-up 1 (2012-2014) of the Longitudinal Study of Adult Health (ELSA-Brasil), a multicenter cohort of Brazilian civil servants. Participants were classified for diabetes using self-reported and clinical information, and evaluated for presence of depressive episodes by the Clinical Interview Schedule-Revised (CIS-R). Associations were estimated by means of logistic regression models (crude and adjusted for socio-demographic variables). RESULTS Women classified as with DM prior to the baseline were at 48% greater risk (95% confidence interval (CI) = 1.03-2.07) of depressive episodes in the crude model and 54% greater risk (95% CI = 1.06-2.19) in the final adjusted model compared to women classified as non-DM. No significant associations were observed for men. The regression models for duration of DM and incidence of depressive episodes (n = 2143 participants; 1160 men and 983 women) returned no significant associations. CONCLUSION In women classified as with prior DM, the greater risk of depressive episodes suggests that more frequent screening for depression may be beneficial as part of a multi-factorial approach to care for DM.
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Affiliation(s)
- Elizabeth Leite Barbosa
- National School of Public Health Sérgio Arouca, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Arlinda B. Moreno
- National School of Public Health Sérgio Arouca, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Eelco Van Duinkerken
- Paulo Niemeyer State Brain Institute, Rio de Janeiro, Brazil
- Graffée and Guinle University Hospital, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Medical Psychology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, the Netherlands
| | - Paulo Lotufo
- University of São Paulo, Cidade Universitária, São Paulo, Brazil
| | - Sandhi Maria Barreto
- Medical School & Clinical Hospital, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Luana Giatti
- Medical School & Clinical Hospital, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | | | | | - Dóra Chor
- National School of Public Health Sérgio Arouca, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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Ceolin G, Rockenbach G, Confortin SC, d’Orsi E, Moreira JD. Association between the consumption of omega-3-rich fish and depressive symptoms in older adults living in a middle-income country: EpiFloripa Aging cohort study. CAD SAUDE PUBLICA 2022; 38:e00011422. [DOI: 10.1590/0102-311xen011422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 10/13/2022] [Indexed: 11/27/2022] Open
Abstract
This study aimed to verify the association between the consumption of omega-3-rich (n-3) fish and depressive symptoms in older adults living in Southern Brazil. This is a cross-sectional analysis with data from the second wave of the EpiFloripa Aging cohort study (2013/2014) including 1,130 individuals aged 60 years or older. The presence of depressive symptoms was measured by the 15-items Geriatric Depression Scale (GDS-15), and the consumption of n-3-rich fish by a question of weekly frequency. The minimum set of variables for adjustment was defined using directed acyclic graph (DAG). Poisson regression with robust error variance was applied (adjusted by Model 1: demographic and socioeconomic variables, Model 2: added behavioral variables, Model 3: added health variables). We identified the prevalence of depressive symptoms in 19% of older adults and 51.8% reported eating n-3-rich fish once a week. Models 1 and 3 showed an inverse association between n-3-rich fish and depressive symptoms. However, the association was reduced when behavioral factors (leisure-time physical activity) were included in Model 2. These findings suggest that n-3-rich fish intake tends to be associated with depressive symptoms in older adults. However, other factors, such as physical exercise, are as pivotal as n-3 fatty acids in preventing the development of depressive symptoms.
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Vulnerabilidade social e transtornos mentais. TEXTOS & CONTEXTOS (PORTO ALEGRE) 2021. [DOI: 10.15448/1677-9509.2021.1.38616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
A saúde mental representa parte essencial da vida das pessoas, podendo resultar no aumento da desigualdade de renda e de vulnerabilidade social. Assim, as relações entre saúde/doença mental e vulnerabilidade social incitam uma série de reflexões e de contextualizações para sua maior compreensão. Esta scoping review apresenta como objetivo mapear as produções científicas sobre as vulnerabilidades das pessoas com transtornos mentais em suas diferentes relações sociais. Divide-se em cinco etapas, com buscas nas bases de dados: MEDLINE via Pubmed; SCOPUS e Academic Search Premier, e busca nas referências dos artigos encontrados, a fim de responder à questão de pesquisa: “Como ocorre à vulnerabilidade das pessoas com transtorno mental em suas diferentes relações sociais?”. Foram encontrados 211 artigos e após as exclusões de estudos não pertinentes, foram incluídos 31 artigos. Os artigos foram organizados em 3 (três) categorias: 1 – a vulnerabilidade das pessoas com transtornos mentais e os serviços de saúde; 2 – a vulnerabilidade das pessoas com transtornos mentais e os determinantes sociais; e 3 – a vulnerabilidade das pessoas com transtornos mentais e a violência/vitimização. Dessa forma, sugere-se o desenvolvimento de mais estudos sobre a temática, assim como a reavaliação das políticas públicas voltadas às pessoas com transtornos mentais, no intuito de se tornarem mais eficazes, tanto na garantia dos direitos desse grupo como na manutenção de sua saúde mental.
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Tüzün H, Demirköse H, Özkan S, İlhan MN. Socioeconomic Factors Related to Prevalence, Severity, and Contact Coverage of Depression in Primary Health Care. PSYCHIAT CLIN PSYCH 2021; 31:457-467. [PMID: 38765649 PMCID: PMC11079699 DOI: 10.5152/pcp.2021.21051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 10/28/2021] [Indexed: 05/22/2024] Open
Abstract
Background We determine factors related to the prevalence, severity, and contact coverage of depression using the Patient Health Questionnaire-9. Methods This cross-sectional study included 1059 individuals who applied to primary health care in Ankara before the onset of pandemic restrictions. Contact coverage was evaluated to include mental health care users. Results The prevalence of depression was 22.9%. Individuals who were unemployed (OR: 3.832; 95% CI: 2.053-7.151), women (OR: 1.646; 95% CI: 1.158-2.340), those without social support (OR: 1.933; 95% CI: 1.219-3.065), those who did not receive formal education (OR: 2.631; 95 % CI: 1.312-5.275), lower-income group (OR: 1.528; 95% CI: 1.071-2.180), and unmarried or divorced (OR: 2.644; 95% CI: 1.324-5.281) were found to be at risk of developing depression. Based on the linear regression model including patients diagnosed with depression, individuals who were unemployed (standardized β: 0.190), women (standardized β: 0.075), those without social support (standardized β: 0.096), and those who were unmarried or single (standardized β: 0.147) had the highest scale scores. Contact coverage for depression was 31.0%. Contact coverage was more likely in the upper-income group (OR: 2.239, 95% CI: 1.173-4.273). Conclusion Although depression is common among primary health care applicants, contact coverage is low. Developing screening programs for depression in primary health care may help improve community mental health. Socioeconomic factors that contribute to the emergence, severity, and contact coverage of depression indicate health inequalities. The development and severity of depression are mostly due to unemployment, which suggests the importance of employment-enhancing policies.
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Affiliation(s)
- Hakan Tüzün
- Department of Public Health, Gazi University Medical Faculty, Ankara, Turkey
| | - Hacer Demirköse
- Department of Public Health, Gazi University Medical Faculty, Ankara, Turkey
| | - Seçil Özkan
- Department of Public Health, Gazi University Medical Faculty, Ankara, Turkey
| | - Mustafa Necmi İlhan
- Department of Public Health, Gazi University Medical Faculty, Ankara, Turkey
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Feter N, Caputo EL, Doring IR, da Silva MC, Reichert FF, Rombaldi AJ. Determinants of increased frequency of depressive and anxiety symptoms in exercise professionals during the COVID-19 pandemic. Work 2021; 70:1057-1067. [PMID: 34842220 DOI: 10.3233/wor-210648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The coronavirus disease (COVID-19) pandemic has affected workers in different health services including exercise professionals (EP). The urgent need to adapt in-person to online activities might have led to increased frequency of anxiety and depressive symptoms. OBJECTIVE We aimed to identify the determinants of aggravated depressive and anxiety symptoms in EP in southern Brazil during social distancing from the COVID-19. METHODS A cross-sectional study was conducted with EP who worked at fitness centers, sports clubs, private schools, or at a public exercise program offered by the municipal council. We used an online-based, self-administered, adapted version of the Hospital Anxiety and Depression scale to compare symptoms of depression and anxiety pre- and during social distancing. RESULTS Participants (n = 201) had a mean age of 32.7±8.0 years, with more than half being male, white, and having an university degree. We observed that 81%and 71%of respondents reported higher frequency in anxiety and depression symptoms, respectively, during social distancing than in the period before it. Physical education teachers, women, non-white professionals, and those with chronic disease were more likely to worsen anxiety symptoms. Women had higher odds to increased frequency in depressive symptoms. Physical activity and previous experience with internet-based tools for working activities reduced the risk of increased depressive symptoms. CONCLUSIONS Sex, ethnicity, chronic diseases, educational level, physical activity, and experience with online tools were determinants for increased frequency of depression and anxiety symptoms in EP.
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Affiliation(s)
- Natan Feter
- Postgraduate Program in Physical Education, Federal University of Pelotas, Pelotas, Brazil.,GEEAF, Physical Activity Epidemiology Research Group, Pelotas, Brazil.,School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD, Australia.,Neuroscience and Physical Activity Research Group, Pelotas, Brazil
| | - Eduardo L Caputo
- Postgraduate Program in Physical Education, Federal University of Pelotas, Pelotas, Brazil.,GEEAF, Physical Activity Epidemiology Research Group, Pelotas, Brazil.,Neuroscience and Physical Activity Research Group, Pelotas, Brazil
| | - Igor R Doring
- GEEAF, Physical Activity Epidemiology Research Group, Pelotas, Brazil
| | - Marcelo C da Silva
- Postgraduate Program in Physical Education, Federal University of Pelotas, Pelotas, Brazil.,GEEAF, Physical Activity Epidemiology Research Group, Pelotas, Brazil
| | - Felipe F Reichert
- Postgraduate Program in Physical Education, Federal University of Pelotas, Pelotas, Brazil.,GEEAF, Physical Activity Epidemiology Research Group, Pelotas, Brazil
| | - Airton J Rombaldi
- Postgraduate Program in Physical Education, Federal University of Pelotas, Pelotas, Brazil.,GEEAF, Physical Activity Epidemiology Research Group, Pelotas, Brazil.,Neuroscience and Physical Activity Research Group, Pelotas, Brazil
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Pitcairn CFM, Laverty AA, Chan JJL, Oyebode O, Mrejen M, Pescarini JM, Machado DB, Hone TV. Inequalities in the prevalence of major depressive disorder in Brazilian slum populations: a cross-sectional analysis. Epidemiol Psychiatr Sci 2021; 30:e66. [PMID: 34670640 PMCID: PMC8546499 DOI: 10.1017/s204579602100055x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/22/2021] [Accepted: 09/24/2021] [Indexed: 11/23/2022] Open
Abstract
AIMS The mental health of slum residents is under-researched globally, and depression is a significant source of worldwide morbidity. Brazil's large slum-dwelling population is often considered part of a general urban-poor demographic. This study aims to identify the prevalence and distribution of depression in Brazil and compare mental health inequalities between slum and non-slum populations. METHODS Data were obtained from Brazil's 2019 National Health Survey. Slum residence was defined based on the UN-Habitat definition for slums and estimated from survey responses. Doctor-diagnosed depression, Patient Health Questionnaire (PHQ-9)-screened depression and presence of undiagnosed depression (PHQ-9-screened depression in the absence of a doctor's diagnosis) were analysed as primary outcomes, alongside depressive symptom severity as a secondary outcome. Prevalence estimates for all outcomes were calculated. Multivariable logistic regression models were used to investigate the association of socioeconomic characteristics, including slum residence, with primary outcomes. Depressive symptom severity was analysed using generalised ordinal logistic regression. RESULTS Nationally, the prevalence of doctor diagnosed, PHQ-9 screened and undiagnosed depression were 9.9% (95% confidence interval (CI): 9.5-10.3), 10.8% (95% CI: 10.4-11.2) and 6.9% (95% CI: 6.6-7.2), respectively. Slum residents exhibited lower levels of doctor-diagnosed depression than non-slum urban residents (8.6%; 95% CI: 7.9-9.3 v. 10.7%; 95% CI: 10.2-11.2), while reporting similar levels of PHQ-9-screened depression (11.3%; 95% CI: 10.4-12.1 v. 11.3%; 95% CI: 10.8-11.8). In adjusted regression models, slum residence was associated with a lower likelihood of doctor diagnosed (adjusted odds ratio (adjusted OR): 0.87; 95% CI: 0.77-0.97) and PHQ-9-screened depression (adjusted OR: 0.87; 95% CI: 0.78-0.97). Slum residents showed a greater likelihood of reporting less severe depressive symptoms. There were significant ethnic/racial disparities in the likelihood of reporting doctor-diagnosed depression. Black individuals were less likely to report doctor-diagnosed depression (adjusted OR: 0.66; 95% CI: 0.57-0.75) than white individuals. A similar pattern was observed in Mixed Black (adjusted OR: 0.72; 95% CI: 0.66-0.79) and other (adjusted OR: 0.63; 95% CI: 0.45-0.88) ethnic/racial groups. Slum residents self-reporting a diagnosis of one or more chronic non-communicable diseases had greater odds of exhibiting all three primary depression outcomes. CONCLUSIONS Substantial inequalities characterise the distribution of depression in Brazil including in slum settings. People living in slums may have lower diagnosed rates of depression than non-slum urban residents. Understanding the mechanisms behind the discrepancy in depression diagnosis between slum and non-slum populations is important to inform health policy in Brazil, including in addressing potential gaps in access to mental healthcare.
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Affiliation(s)
| | - Anthony A. Laverty
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | | | | | - Matías Mrejen
- São Paulo School of Business Administration, Fundação Getulio Vargas, São Paulo, Brazil
- Instituto de Estudos para Políticas de Saúde (IEPS), São Paulo, Brazil
| | - Julia M. Pescarini
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz, Salvador, Brazil
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Daiane Borges Machado
- Center of Data and Knowledge Integration for Health, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Thomas V. Hone
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
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Salgado MA, Fortes SLCL. [Mental health indicators in primary healthcare: assessment of the quality of access through case detection capacity]. CAD SAUDE PUBLICA 2021; 37:e00178520. [PMID: 34669772 DOI: 10.1590/0102-311x00178520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 01/08/2021] [Indexed: 11/22/2022] Open
Abstract
The objective was to demonstrate the rate of detection of mental disorders in primary healthcare units as a marker of access and indicator of care in mental health. A comparative case study was performed in the electronic patient files of adults seen in two neighboring primary care units in the city of Rio de Janeiro, Brazil, in 2015-2016 and 2016-2017. Diagnoses of mental disorders were extracted, using the International Classification of Diseases, dividing them into three groups: common mental disorders (CMD: F32; F33 F40-45, except F42, and R45), severe mental disorders (SMD: F20-F29; F31-F39), and alcohol and drug use (AD: F10-F19 and Z72). The results were compared to the community prevalence of mental disorders reported in the literature. Statistical analysis was applied with the chi-square test, in addition to a qualitative analysis of each unit´s scenario. Unit A (2015-2016) showed a low detection rate for all disorders [SMD = 45 (0.8%); CMD = 148 (2.64%) and AD = 0]; unit B detected about 50% of the expected cases [SMD = 23 (0.98%); CMD = 140 (5.97%) and AD = 130 (5.54%)]. In 2016-2017 there was an increase in the overall detection of mental disorders at unit A [SMD = 89 (1.6%); CMD = 298 (5.24%) and AD = 7 (0.12%)], in unit B the detection rate remained similar [SMD = 25 (1.0%); CMD = 176 (7.14%) and AD = 121 (4.9%)]. Changes in the units were detected. Distinction in the detection rate was used as an indicator for analysis of mental health care, allowing the study of factors potentially associated with this variation, influencing access to care. Monitoring this indicator helps improve mental health care.
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Vieira FDST, Muraro AP, Rodrigues PRM, Sichieri R, Pereira RA, Ferreira MG. Lifestyle-related behaviors and depressive symptoms in college students. CAD SAUDE PUBLICA 2021; 37:e00202920. [PMID: 34644759 DOI: 10.1590/0102-311x00202920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 01/08/2021] [Indexed: 12/15/2022] Open
Abstract
This study sought to examine the association between lifestyle-related behaviors and depressive symptoms among college students. This cross-sectional study analyzed baseline data of a dynamic-cohort study from a public university in Central-Western Brazil, in all 21 undergraduate full-time courses. Students up to 25 years old who were enrolled for the first time in a university were included in the study, except pregnant and/or nursing women. All students who met the eligibility criteria were invited to participate in the study. From a total of 1,212 eligible students, 1,038 were included (85.6%). All participants answered a self-administered questionnaire on smoking, alcohol consumption, screen time, sleep duration, and meal patterns. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9). Multivariate Poisson regression models stratified by sex were used to estimate the associations. Depressive symptoms was observed in 31.6% (males 23.6%; females 39.9%; p-value chi-square test = 0.01) of the students. Smoking, drinking spirits, and having irregular meal habits were directly associated with depressive symptoms in both males and females. The co-occurrence of two risk behaviors (men: aPR = 2.23, 95%CI: 1.25; 3.99; women: aPR = 1.54, 95%CI: 1.03; 2.30) and three or more risk behaviors (men: aPR = 3.42, 95%CI: 1.90; 6.16; women: aPR = 2.09, 95%CI: 1.39; 3.15) increased the occurrence of depressive symptoms among the students. Lifestyle-related unhealthy behaviors were associated with an increased occurrence of depressive symptoms among college students. These findings suggest the need of interventions encouraging changes in lifestyle to promote mental health and to improve the quality of life in this group.
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Affiliation(s)
| | - Ana Paula Muraro
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil
| | | | - Rosely Sichieri
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Rosangela Alves Pereira
- Departamento de Nutrição Social e Aplicada, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
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Vera Cruz Dos Santos D, Coelho de Soárez P, Cavero V, U Rocha TI, Aschar S, Daley KL, Garcia Claro H, Abud Scotton G, Fernandes I, Diez-Canseco F, Brandt LR, Toyama M, Martins Castro HC, Miranda JJ, Araya R, Quayle J, Rossi Menezes P. A Mobile Health Intervention for Patients With Depressive Symptoms: Protocol for an Economic Evaluation Alongside Two Randomized Trials in Brazil and Peru. JMIR Res Protoc 2021; 10:e26164. [PMID: 34643538 PMCID: PMC8552099 DOI: 10.2196/26164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 05/04/2021] [Accepted: 06/09/2021] [Indexed: 11/28/2022] Open
Abstract
Background Mobile health interventions provide significant strategies for improving access to health services, offering a potential solution to reduce the mental health treatment gap. Economic evaluation of this intervention is needed to help inform local mental health policy and program development. Objective This paper presents the protocol for an economic evaluation conducted alongside 2 randomized controlled trials (RCTs) to evaluate the cost-effectiveness of a psychological intervention delivered through a technological platform (CONEMO) to treat depressive symptoms in people with diabetes, hypertension, or both. Methods The economic evaluation uses a within-trial analysis to evaluate the incremental costs and health outcomes of CONEMO plus enhanced usual care in comparison with enhanced usual care from public health care system and societal perspectives. Participants are patients of the public health care services for hypertension, diabetes, or both conditions in São Paulo, Brazil (n=880) and Lima, Peru (n=432). Clinical effectiveness will be measured by reduction in depressive symptoms and gains in health-related quality of life. We will conduct cost-effectiveness and cost-utility analyses, providing estimates of the cost per at least 50% reduction in 9-item Patient Health Questionnaire scores, and cost per quality-adjusted life year gained. The measurement of clinical effectiveness and resource use will take place over baseline, 3-month follow-up, and 6-month follow-up in the intervention and control groups. We will use a mixed costing methodology (ie, a combination of top–down and bottom–up approaches) considering 4 cost categories: intervention (CONEMO related) costs, health care costs, patient and family costs, and productivity costs. We will collect unit costs from the RCTs and national administrative databases. The multinational economic evaluations will be fully split analyses with a multicountry costing approach. We will calculate incremental cost-effectiveness ratios and present 95% CIs from nonparametric bootstrapping (1000 replicates). We will perform deterministic and probabilistic sensitivity analyses. Finally, we will present cost-effectiveness acceptability curves to compare a range of possible cost-effectiveness thresholds. Results The economic evaluation project had its project charter in June 2018 and is expected to be completed in September 2021. The final results will be available in the second half of 2021. Conclusions We expect to assess whether CONEMO plus enhanced usual care is a cost-effective strategy to improve depressive symptoms in this population compared with enhanced usual care. This study will contribute to the evidence base for health managers and policy makers in allocating additional resources for mental health initiatives. It also will provide a basis for further research on how this emerging technology and enhanced usual care can improve mental health and well-being in low- and middle-income countries. Trial Registration ClinicalTrials.gov NCT12345678 (Brazil) and NCT03026426 (Peru); https://clinicaltrials.gov/ct2/show/NCT02846662 and https://clinicaltrials.gov/ct2/show/NCT03026426 International Registered Report Identifier (IRRID) DERR1-10.2196/26164
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Affiliation(s)
| | - Patrícia Coelho de Soárez
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Victoria Cavero
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Thaís I U Rocha
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Suzana Aschar
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Kate Louise Daley
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Heloísa Garcia Claro
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.,Faculdade de Enfermagem, Universidade Estadual de Campinas, Campinas, Brazil
| | - George Abud Scotton
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Ivan Fernandes
- CECS Centro de Engenharia, Modelagem e Ciências Sociais Aplicadas, Universidade Federal do ABC, São Bernardo do Campo, Brazil
| | - Francisco Diez-Canseco
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Lena Rebeca Brandt
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Mauricio Toyama
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.,Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Ricardo Araya
- Centre for Global Mental Health and Primary Care Research, Health Service and Population Research, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | - Julieta Quayle
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Paulo Rossi Menezes
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Use of Data to Understand the Social Determinants of Depression in Two Middle-Income Countries: the 3-D Commission. J Urban Health 2021; 98:41-50. [PMID: 34409557 PMCID: PMC8373292 DOI: 10.1007/s11524-021-00559-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/07/2021] [Indexed: 12/11/2022]
Abstract
Depression accounts for a large share of the global disease burden, with an estimated 264 million people globally suffering from depression. Despite being one of the most common kinds of mental health (MH) disorders, much about depression remains unknown. There are limited data about depression, in terms of its occurrence, distribution, and wider social determinants. This work examined the use of novel data sources for assessing the scope and social determinants of depression, with a view to informing the reduction of the global burden of depression.This study focused on new and traditional sources of data on depression and its social determinants in two middle-income countries (LMICs), namely, Brazil and India. We identified data sources using a combination of a targeted PubMed search, Google search, expert consultations, and snowball sampling of the relevant literature published between October 2010 and September 2020. Our search focused on data sources on the following HEALTHY subset of determinants: healthcare (H), education (E), access to healthy choices (A), labor/employment (L), transportation (T), housing (H), and income (Y).Despite the emergence of a variety of data sources, their use in the study of depression and its HEALTHY determinants in India and Brazil are still limited. Survey-based data are still the most widely used source. In instances where new data sources are used, the most commonly used data sources include social media (twitter data in particular), geographic information systems/global positioning systems (GIS/GPS), mobile phone, and satellite imagery. Often, the new data sources are used in conjunction with traditional sources of data. In Brazil, the limited use of new data sources to study depression and its HEALTHY determinants may be linked to (a) the government's outsized role in coordinating healthcare delivery and controlling the data system, thus limiting innovation that may be expected from the private sector; (b) the government routinely collecting data on depression and other MH disorders (and therefore, does not see the need for other data sources); and (c) insufficient prioritization of MH as a whole. In India, the limited use of new data sources to study depression and its HEALTHY determinants could be a function of (a) the lack of appropriate regulation and incentives to encourage data sharing by and within the private sector, (b) absence of purposeful data collection at subnational levels, and (c) inadequate prioritization of MH. There is a continuing gap in the collection and analysis of data on depression, possibly reflecting the limited priority accorded to mental health as a whole. The relatively limited use of data to inform our understanding of the HEALTHY determinants of depression suggests a substantial need for support of independent research using new data sources. Finally, there is a need to revisit the universal health coverage (UHC) frameworks, as these frameworks currently do not include depression and other mental health-related indicators so as to enable tracking of progress (or lack thereof) on such indicators.
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Springer PR, Falceto O, Bischoff RJ, Barros E, Scheeren P, Taylor NC, Cargnin D. A pilot study of a family systems oriented telemental health model in rural Brazil. JOURNAL OF MARITAL AND FAMILY THERAPY 2021; 47:533-548. [PMID: 33742717 DOI: 10.1111/jmft.12500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 02/04/2021] [Accepted: 02/06/2021] [Indexed: 06/12/2023]
Abstract
There are large disparities in access to mental health care, especially in low- and middle-income countries. Telemental health is a viable solution to reducing these disparities, but quality research demonstrating its effectiveness is needed. The purpose of this pilot study was to examine the feasibility of a telemental health approach in a rural region of Brazil. Primary care providers referred patients diagnosed with depression and anxiety to a 12-session family systems-oriented telemental health program developed by the researchers. Participants (n = 10) received therapy by family systems trained therapists. While sessions were delivered via telemental health, each received one face-to-face session as part of the treatment regimen. Results from the one-tailed t-tests indicate reductions in psychosocial symptoms and improvements in family functioning with medium and large effect sizes. Findings reveal that a family systems-oriented telemental health approach is a promising intervention for improving mental health outcomes in a middle-income country.
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Affiliation(s)
- Paul R Springer
- Department of Child, Youth, and Family Studies, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Olga Falceto
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Richard J Bischoff
- Institute of Agriculture and Natural Resources, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Enrique Barros
- Clinica da Familia Teewald Santa Maria do Herval and the Universidade de Caxias do Sul, Caxias do Sul, Brazil
| | | | - Nathan C Taylor
- School of Applied Human Sciences, University of Northern Iowa, Cedar Falls, IA, USA
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Bezerra HDS, Alves RM, de Souza TA, Medeiros ADA, Barbosa IR. Factors Associated With Mental Suffering in the Brazilian Population: A Multilevel Analysis. Front Psychol 2021; 12:625191. [PMID: 33841256 PMCID: PMC8026874 DOI: 10.3389/fpsyg.2021.625191] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 02/26/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: To analyze how individual characteristics and the social context are associated with mental distress symptoms in the Brazilian population. Method: A multilevel cross-sectional study with data from the 2013 National Health Survey. There were two dependent variables: (a) decreased vital energy and somatic symptoms, (b) the presence of depressive thoughts. The independent variables were biological characteristics, education and income, habits and lifestyle, and context variables. Bivariate analysis was performed, and Prevalence Ratios calculated in a Poisson Regression (95% CI). A multilevel Poisson Regression was performed to verify the effect of individual and contextual variables. Results: Regarding depressive thoughts, young and middle-aged individuals, low education, women, absence of partner, smokers or former smokers, and absence of health insurance were the categories at highest risk; belonging to classes D-E and living in states with lower expected years of schooling proved to be protective factors. Similar results were found for the second outcome. Conclusions: Symptoms of mental distress were associated with the individual characteristics and contextual aspects of the federation unit. These findings indicate the importance of strengthening psychosocial care aimed at vulnerable groups.
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Affiliation(s)
| | - Roberta Machado Alves
- Graduate Program in Public Health, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Talita Araujo de Souza
- Graduate Program of Health Sciences, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Arthur de Almeida Medeiros
- Graduate Program in Public Health, Federal University of Rio Grande do Norte, Natal, Brazil.,Integrated Health Institute, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
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Mari JJ, Gadelha A, Kieling C, Ferri CP, Kapczinski F, Nardi AE, Almeida-Filho N, Sanchez ZM, Salum GA. Translating science into policy: mental health challenges during the COVID-19 pandemic. ACTA ACUST UNITED AC 2021; 43:638-649. [PMID: 33710250 PMCID: PMC8639016 DOI: 10.1590/1516-4446-2020-1577] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 12/02/2020] [Indexed: 12/20/2022]
Abstract
Several stressors associated with the coronavirus disease 2019 (COVID-19) are expected to affect the mental health of global populations: the effects of physical distancing, quarantine, and social isolation; the emotional suffering of health and other frontline workers; neuropsychiatric sequelae in those affected by the virus; the impact to families of lives lost to the disease; differential effects for those with severe mental disorders; and the consequences of social and economic deterioration. In this context, we sought: to form a panel of Brazilian experts on child and adolescent health, neurodevelopment, health services, and adult and elderly mental health; and to compile evidence-based interventions to support suggested policy changes in Brazil to mitigate the expected increase in mental health disorders during the pandemic and its mental health consequences. The following actions are recommended: 1) invest in prevention programs for the safe return of students to schools; 2) adopt evidence-based psychosocial interventions to maintain an adequate environment for child and adolescent development; 3) target socially vulnerable populations and those experiencing discrimination; 4) train primary care teams to solve common mental health problems, provide needs-based assessments, and manage long-term, at-home care for older patients; 5) invest in technological advancements (e.g., telemedicine, e-Health, and web-based algorithms) to promote coordinated care; 6) increase access to and literacy in the use of computers and mobile phones, especially among older adults; 7) expand protocols for remote, brief psychotherapy interventions and psychoeducation to manage common mental health problems.
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Affiliation(s)
- Jair J Mari
- Departamento de Psiquiatria e Psicologia Médica, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Ary Gadelha
- Departamento de Psiquiatria e Psicologia Médica, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Christian Kieling
- Serviço de Psiquiatria da Infância e Adolescência, Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Departamento de Psiquiatria e Medicina Legal, UFRGS, Porto Alegre, RS, Brazil
| | - Cleusa P Ferri
- Departamento de Psiquiatria e Psicologia Médica, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Flavio Kapczinski
- Departamento de Psiquiatria, UFRGS, Porto Alegre, RS, Brazil.,McMaster University, Hamilton, Canada
| | - Antonio E Nardi
- Instituto de Psiquiatria, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.,Academia Nacional de Medicina, Rio de Janeiro, RJ, Brazil.,Academia Brasileira de Ciências, Rio de Janeiro, RJ, Brazil
| | - Naomar Almeida-Filho
- Instituto de Estudos Avançados, Universidade de São Paulo, São Paulo, SP, Brazil.,Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, BA, Brazil
| | - Zila M Sanchez
- Departamento de Medicina Preventiva, Escola Paulista de Medicina, UNIFESP, São Paulo, SP, Brazil
| | - Giovanni A Salum
- Seção de Afeto Negativo e Processos Sociais, Departamento de Psiquiatria e Medicina Legal, HCPA, UFRGS, Porto Alegre, RS, Brazil
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Sharp increase in depression and anxiety among Brazilian adults during the COVID-19 pandemic: findings from the PAMPA cohort. Public Health 2020; 190:101-107. [PMID: 33387848 PMCID: PMC7773543 DOI: 10.1016/j.puhe.2020.11.013] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 11/17/2020] [Accepted: 11/17/2020] [Indexed: 12/27/2022]
Abstract
Objectives We aimed to compare the prevalence of depression and anxiety symptoms before and during the pandemic and identify factors associated with aggravated mental health symptoms. Study design Retrospective cohort study. Methods We identified the proportion of normal, mild, moderate, and severe symptoms of depression and anxiety before and during the social distancing restrictions in adults from southern Brazil. An online, self-administered questionnaire was delivered for residents within the state of Rio Grande do Sul. Depressive and anxiety symptoms were examined by the Hospital Anxiety and Depression Scale. Results Most of the participants (n = 2314) aged between 31 and 59 years (54.2%), were women (76.6%), White (90.6%) with a university degree (66.6%). Moderate-to-severe symptoms of depression and anxiety were reported in 3.9% and 4.5% of participants, respectively, before COVID-19. During the pandemic (June–July, 2020), these proportions increased to 29.1% (6.6-fold increase) and 37.8% (7.4-fold increase), respectively. Higher rates of depressive and anxiety symptoms were observed among women, those aged 18–30 years, diagnosed with chronic disease and participants who had their income negatively affected by social restrictions. Remaining active or becoming physically active during social distancing restrictions reduced the probability of aggravated mental health disorders. Conclusions Depressive and anxiety symptoms had a 6.6- and 7.4-fold increase since the COVID-19 pandemic. Public policies such as physical activity promotion and strategies to reduce the economic strain caused by this pandemic are urgently needed to mitigate the impact of the pandemic on mental health.
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Dantas MNP, Souza DLBD, Souza AMGD, Aiquoc KM, Souza TAD, Barbosa IR. Factors associated with poor access to health services in Brazil. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2020; 24:e210004. [PMID: 33331413 DOI: 10.1590/1980-549720210004] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 08/11/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze factors associated with poor access to health services among the Brazilian population aged 19 years or older. METHODS This is a cross-sectional study based on data from the 2013 National Health Survey, obtained from a complex sample. The poor access outcome was defined as not having received care the last time the participant sought a health service and not seeking care again for lack of accessibility. We analyzed the prevalence of poor access and its association with socioeconomic and health factors by calculating prevalence ratios (PR) with 95% confidence intervals. We also used Poisson's multivariate regression model with the Wald test for robust estimation. RESULTS Out of the 60,202 valid responses, 12,435 individuals met the criteria for poor access. Poor access had a prevalence of 18.1% (95%CI 16.8 - 19.4) and was associated with the following factors: being black/multiracial (PR = 1.2; 95%CI 1.0 - 1.4); living in the North (PR = 1.5; 1.3 - 1.9) and Northeast (PR = 1.4; 1.2 - 1.6) regions compared to the Southeast region; living in a rural area (PR = 1.2; 1.1 - 1.4); being a smoker (PR = 1.2; 1.0 - 1.4); having poor/very poor self-rated health (PR = 1.3; 1.1 - 1.6); not having private health insurance (PR = 2.3; 1.7 - 2.9). CONCLUSION Access to health services is still precarious for a considerable part of the Brazilian population, especially the most vulnerable groups.
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Affiliation(s)
| | | | - Ana Mayara Gomes de Souza
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Rio Grande do Norte - Natal (RN), Brasil
| | - Kezauyn Miranda Aiquoc
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Rio Grande do Norte - Natal (RN), Brasil
| | - Talita Araujo de Souza
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal do Rio Grande do Norte - Natal (RN), Brasil
| | - Isabelle Ribeiro Barbosa
- Faculdade de Ciências da Saúde do Trairi, Universidade Federal do Rio Grande do Norte - Santa Cruz (RN), Brasil
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Constante HM, Bastos JL. Mapping the Margins in Health Services Research: How Does Race Intersect With Gender and Socioeconomic Status to Shape Difficulty Accessing HealthCare Among Unequal Brazilian States? INTERNATIONAL JOURNAL OF HEALTH SERVICES 2020; 51:155-166. [PMID: 33323017 DOI: 10.1177/0020731420979808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Research on healthcare inequities has centralized whether marginalized racial, gender, or socioeconomic (SES) groups are afforded equitable access to care, yet scant investigations have focused on how race intersects with other social statuses to shape difficulty accessing health services. Contextual specificity has also been under-researched in this field of knowledge. Data from 59,249 respondents 18 years of age and over from the 2013 Brazilian National Health Survey were analyzed using multilevel regressions models. We test 3 hypotheses: racial, gender, and socioeconomically oppressed groups are each more likely to report difficulty accessing health services (H1); compared to high-SES white men, low-SES Black women report expressively higher frequencies of the outcome (H2); and intersectional healthcare inequities are larger among low-SES Brazilian states (H3). Partially supporting H1 and H2, results suggest that race and SES, but not gender, are each strong predictors of difficulty accessing healthcare, with low-SES Black respondents facing the highest odds of reporting this outcome. Although H3 was not supported, intersectional groups residing in low-SES Brazilian states were more likely to report difficulty accessing healthcare. This study demonstrated that, together with contextual specificity, the intersections of race with other axes of marginalization should be at the forefront of research and policy addressing healthcare inequities.
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Affiliation(s)
- Helena Mendes Constante
- Federal University of Santa Catarina, Campus Universitário, Trindade, Florianópolis, Santa Catarina, Brazil
| | - João Luiz Bastos
- Federal University of Santa Catarina, Campus Universitário, Trindade, Florianópolis, Santa Catarina, Brazil
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Ceolin G, Matsuo LH, Confortin SC, D'Orsi E, Rieger DK, Moreira JD. Lower serum 25-hydroxycholecalciferol is associated with depressive symptoms in older adults in Southern Brazil. Nutr J 2020; 19:123. [PMID: 33189154 PMCID: PMC7666456 DOI: 10.1186/s12937-020-00638-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 10/27/2020] [Indexed: 12/21/2022] Open
Abstract
Background Older adults are one of the most susceptible populations to depression, especially those living in low- and middle-income countries. As well, they are also considering a risk group for vitamin D deficiency. Low serum vitamin D has been associated with an increased risk of brain neuropsychiatry disorders. We aimed to investigate the association between serum 25-hydroxycholecalciferol concentrations and depressive symptoms in adults aged 60 years and over from southern Brazil. Methods A cross-sectional analysis was performed using data collected during 2013–2014 from the populational-based longitudinal EpiFloripa Aging Study (n = 1197). Serum 25-hydroxycholecalciferol concentrations were analyzed and classified according to the Endocrine Society reference values [sufficiency (≥ 30 ng/mL), insufficiency (21–29 ng/mL), and deficiency (≤ 20 ng/mL)]. Depressive symptoms were evaluated using the Geriatric Depression Scale (15-item GDS). Logistic regression was performed to assess depressive symptoms in each vitamin D category. The analysis was adjusted for sex, age, skin color, family income, leisure-time physical activities, social or religious groups attendance, morbidities, cognitive impairment, and dependence in activities of daily living. Results A total of 557 participants with complete data for exposure and outcome were enrolled in the analysis. Most of the sample participants were female (63.1%), age-range 60–69 years (42.2%), white skin color (85.1%), and vitamin D serum level samples were collected in autumn (50.7%). Depressive symptoms were present in 15.8% of the participants, and the prevalence was higher in individuals classified as deficient in vitamin D (23.2, 95% confidence interval [CI] = 15.6;32.9) and insufficiency (17.2, 95%CI = 11.0;25.9). The crude analysis showed that vitamin D deficient participants had 3.08 (CI = 1.53;6.20) times higher odds to present depressive symptoms compared to vitamin D sufficiency. After adjusting, the association was maintained [OR 2.27 (95%CI = 1.05;4.94). Conclusions Serum 25-hydroxycholecalciferol deficiency was positively associated with depressive symptoms in older adults from southern Brazil.
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Affiliation(s)
- Gilciane Ceolin
- Postgraduate Program in Nutrition, Federal University of Santa Catarina, Florianopolis, Brazil
| | - Luísa Harumi Matsuo
- Postgraduate Program in Nutrition, Federal University of Santa Catarina, Florianopolis, Brazil
| | | | - Eleonora D'Orsi
- Department of Public Health, Postgraduate Program in Public Health, Federal University of Santa Catarina, Florianopolis, Brazil
| | - Débora Kurrle Rieger
- Department of Nutrition, Translational Nutritional Neuroscience Working Group, Postgraduate Program in Nutrition, Federal University of Santa Catarina, Florianopolis, Brazil.,Translational Nutritional Neuroscience Working Group. Postgraduate Program in Nutrition. Department of Nutrition, Universidade Federal de Santa Catarina. Centro de Ciências da Saúde, Campus Universitário - Trindade, Florianópolis, Santa Catarina, 88040-900, Brazil
| | - Júlia Dubois Moreira
- Department of Nutrition, Translational Nutritional Neuroscience Working Group, Postgraduate Program in Nutrition, Federal University of Santa Catarina, Florianopolis, Brazil. .,Translational Nutritional Neuroscience Working Group. Postgraduate Program in Nutrition. Department of Nutrition, Universidade Federal de Santa Catarina. Centro de Ciências da Saúde, Campus Universitário - Trindade, Florianópolis, Santa Catarina, 88040-900, Brazil.
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Bonadiman CSC, Malta DC, de Azeredo Passos VM, Naghavi M, Melo APS. Depressive disorders in Brazil: results from the Global Burden of Disease Study 2017. Popul Health Metr 2020; 18:6. [PMID: 32993670 PMCID: PMC7526360 DOI: 10.1186/s12963-020-00204-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 06/19/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Depression is one of the major causes of disability worldwide. The objective of this study was to analyze the results of the Global Burden of Disease Study 2017 (GBD-2017) for depressive disorders in Brazil and its Federated Units (FUs) in 1990 and 2017. METHODS We used GBD-2017 study methodology to evaluate the prevalence estimates, the disability-adjusted life-year (DALY), and the years lived with disability (YLDs) for depressive disorders, which include major depressive disorder and dysthymia. The YLD estimates and the position of these disorders in the DALY and YLD rankings were compared to those of seven other countries. The observed versus expected YLD, based on the sociodemographic index (SDI), were compared. RESULTS In GBD-2017, the prevalence of depressive disorders in Brazil was 3.30% (95% uncertainty interval [UI]: 3.08 to 3.57), ranging from 3.79% (3.53 to 4.09) in Santa Catarina to 2.78% in Pará (2.56 to 3.03), with significant differences between the Federated Units. From 1990 to 2017, there was an increase in number of YLD (55.19%, 49.57 to 60.73), but a decrease in the age-standardized rates (- 9.01%, - 11.66 to - 6.31). The highest proportion of YLD was observed in the age range of 15-64 years and among females. These disorders rank 4th and 13th as leading causes of YLD and DALY, respectively, in Brazil. In the other countries evaluated, the ranking of these disorders in the YLD classification was close to Brazil's, while in the DALY classification, there was higher variability. All countries had YLD rates similar to the overall rate. The observed/expected YLD ratio ranged from 0.81 in Pará to 1.16 in Santa Catarina. Morbidity of depressive disorders was not associated with SDI. CONCLUSIONS Depressive disorders have been responsible for a high disability burden since 1990, especially in adult women living in the Southern region of the country. The number of people affected by these disorders in the country tends to increase, requiring more investment in mental health aimed at advancements and quality of services. The epidemiological studies of these disorders throughout the national territory can contribute to this planning and to making the Brazilian health system more equitable.
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Affiliation(s)
- Cecília Silva Costa Bonadiman
- Faculdade de Medicina, Programa de Pós- Graduação em Saúde Pública, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Deborah Carvalho Malta
- Departamento de Enfermagem Materno Infantil e Saúde Pública, Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Valéria Maria de Azeredo Passos
- Departamento de Enfermagem Materno Infantil e Saúde Pública, Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.,Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | - Ana Paula Souto Melo
- Faculdade de Medicina, Programa de Pós- Graduação em Saúde Pública, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil. .,Faculdade de Medicina, Universidade Federal de São João Del Rei, Divinópolis, MG, 35501-296, Brazil.
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Leite JS, Feter N, Caputo EL, Doring IR, Cassuriaga J, Reichert FF, Silva MCD, Rombaldi AJ. Managing noncommunicable diseases during the COVID-19 pandemic in Brazil: findings from the PAMPA cohort. CIENCIA & SAUDE COLETIVA 2020; 26:987-1000. [PMID: 33729353 DOI: 10.1590/1413-81232021263.39232020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 11/18/2020] [Indexed: 11/22/2022] Open
Abstract
The objective was to identify the impact of social distance in the management of noncommunicable diseases (NCD) in the adult population from the state of Rio Grande do Sul, southern Brazil. This is an ambispective, population-based cohort study. Descriptive analysis and Poisson regression models were used and the results were reported as prevalence ratio and 95% confidence intervals. From a total of 1,288 participants, 43.1% needed medical care and 28.5% reported impaired management of NCDs during social distance. Female sex, age between 18 and 30 years old, living in the Serra region (central region of the state), people with depression and multimorbidity were more likely to have impaired management of NCDs. Being physically active reduced the probability of having impaired management of NCD by 15%. Reduced monthly income was associated with the difficulty in accessing prescription medicine and avoidance of seeking in-person medical assistance. Depression was associated with difficulties in accessing medications, while avoidance of seeking in-person medical assistance was more likely for people with multimorbidity, arthritis/arthrosis/fibromyalgia, heart disease, and high cholesterol.
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Affiliation(s)
- Jayne Santos Leite
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal do Rio Grande do Sul. R. Ramiro Barcelos 2400, Campus Saúde. 90035-003 Porto Alegre RS Brasil.
| | - Natan Feter
- School of Human Movement and Nutrition Sciences, Universidade de Queensland. Queensland Austrália.,Programa de Pós-Graduação em Educação Física, Universidade Federal de Pelotas. Pelotas RS Brasil.,Grupo de Pesquisa em Epidemiologia da Atividade Física, Universidade Federal de Pelotas. Pelotas RS Brasil
| | - Eduardo Lucia Caputo
- Programa de Pós-Graduação em Educação Física, Universidade Federal de Pelotas. Pelotas RS Brasil.,Grupo de Pesquisa em Epidemiologia da Atividade Física, Universidade Federal de Pelotas. Pelotas RS Brasil
| | - Igor Retzlaff Doring
- Grupo de Pesquisa em Epidemiologia da Atividade Física, Universidade Federal de Pelotas. Pelotas RS Brasil
| | - Júlia Cassuriaga
- Programa de Pós-Graduação em Educação Física, Universidade Federal de Pelotas. Pelotas RS Brasil
| | - Felipe Fossati Reichert
- Programa de Pós-Graduação em Educação Física, Universidade Federal de Pelotas. Pelotas RS Brasil.,Grupo de Pesquisa em Epidemiologia da Atividade Física, Universidade Federal de Pelotas. Pelotas RS Brasil
| | - Marcelo Cozzensa da Silva
- Programa de Pós-Graduação em Educação Física, Universidade Federal de Pelotas. Pelotas RS Brasil.,Grupo de Pesquisa em Epidemiologia da Atividade Física, Universidade Federal de Pelotas. Pelotas RS Brasil
| | - Airton José Rombaldi
- Programa de Pós-Graduação em Educação Física, Universidade Federal de Pelotas. Pelotas RS Brasil.,Grupo de Pesquisa em Epidemiologia da Atividade Física, Universidade Federal de Pelotas. Pelotas RS Brasil
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Fernandes CSE, Lima MG, Barros MBDA. Emotional problems and the use of psychotropic drugs: investigating racial inequality. CIENCIA & SAUDE COLETIVA 2020; 25:1677-1688. [PMID: 32402020 DOI: 10.1590/1413-81232020255.33362019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 08/07/2019] [Indexed: 01/08/2023] Open
Abstract
The aim of the present study was to investigate the existence of racial inequalities in the prevalence of emotional problems, the search for healthcare services and the use of psychotropic drugs. A population-based, cross-sectional study was conducted with data from the 2014/15 Campinas Health Survey. Sample of 1953 individuals aged 20 years or older was analyzed. We estimated the prevalence of common mental disorders (CMDs), the reporting of emotional problems, insomnia, the search for and the use of healthcare services and the use of psychotropic drugs according to self-reported skin color (white and black/brown). Prevalence ratios were estimated using "Poisson" multiple regression. The prevalence of CMDs was higher among blacks/brown compared to whites but no difference was found regarding the reporting of emotional problems and insomnia. Whites sought healthcare services more due to emotional problems. The use of psychotropic drugs was also higher among whites. The results revealed racial inequalities in the presence of CMDs, the search for healthcare services and the use of psychotropics drugs, highlighting the need for actions to identify and overcome barriers that hinder access to mental health care by different racial segments of the population.
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Affiliation(s)
| | - Margareth Guimarães Lima
- Departamento de Saúde Coletiva, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil,
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Noubani A, Diaconu K, Ghandour L, El Koussa M, Loffreda G, Saleh S. A community-based system dynamics approach for understanding factors affecting mental Health and Health seeking behaviors in Beirut and Beqaa regions of Lebanon. Global Health 2020; 16:28. [PMID: 32228648 PMCID: PMC7106684 DOI: 10.1186/s12992-020-00556-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 03/10/2020] [Indexed: 02/05/2024] Open
Abstract
Background Available evidence on mental health and psychosocial problems in Lebanon is limited. Recent quantitative data suggests a high prevalence among Syrian refugees and their Lebanese host communities, with significant treatment gaps in both populations. This study aims to determine how Lebanese host and Syrian refugee communities perceive mental health, and identify health seeking behaviors and barriers to health access in two contrasting contexts of fragility. Methods A comparative qualitative study design was adopted whereby a total of 36 semi-structured interviews with Lebanese host and Syrian refugees’ community members were conducted, followed by a series of four participatory group model building (GMB) sessions. Participants were recruited from two contrasting fragility contexts: Beirut and Beqaa regions. During these sessions, causal loop diagrams were elicited depicting shared understandings of factors prompting the onset of mental health and psychosocial issues; health seeking behaviors, pathways and elements affecting the rate of health improvement and maintenance were also identified. Results Community members in both settings had similar perceptions of factors contributing to mental health. Participants named long-term effects of exposure to wars, political and social effects of conflicts, and financial constraints at the household level as precipitating factors prompting the onset of mental health and psychosocial stressors. Gender and integration related challenges between communities were identified as factors that affect condition onset and associated care seeking. Pathways for health seeking were found to be shaped by trust, the advice and support of loved ones, and the need to ensure confidentiality of affected individuals. Recurrent themes in discussion highlighted major barriers to healthcare access including significant delays in health care seeking from the formal health system, widespread social stigma, prohibitive service costs, lack of health coverage, limited awareness of mental health service availability and limited trust in the quality of services available. Conclusion Mental health and psychosocial support strategies need to be gender- and integration-sensitive, primarily focused on condition prevention and awareness raising in order to strengthen health-seeking behaviors.
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Affiliation(s)
- Aya Noubani
- Global Health Institute, American University of Beirut, Beirut, Lebanon.,NIHR Research Unit on Health in Situations of Fragility, Institute for Global Health and Development, Queen Margaret University, Musselburgh, UK
| | - Karin Diaconu
- NIHR Research Unit on Health in Situations of Fragility, Institute for Global Health and Development, Queen Margaret University, Musselburgh, UK
| | - Lilian Ghandour
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
| | - Maria El Koussa
- Global Health Institute, American University of Beirut, Beirut, Lebanon.,NIHR Research Unit on Health in Situations of Fragility, Institute for Global Health and Development, Queen Margaret University, Musselburgh, UK
| | - Giulia Loffreda
- NIHR Research Unit on Health in Situations of Fragility, Institute for Global Health and Development, Queen Margaret University, Musselburgh, UK
| | - Shadi Saleh
- Global Health Institute, American University of Beirut, Beirut, Lebanon.,NIHR Research Unit on Health in Situations of Fragility, Institute for Global Health and Development, Queen Margaret University, Musselburgh, UK
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Guimarães RA, Morais Neto OL. Prevalence and Factors Associated with Driving Under the Influence of Alcohol in Brazil: An Analysis by Macroregion. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030767. [PMID: 31991757 PMCID: PMC7037342 DOI: 10.3390/ijerph17030767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/14/2020] [Accepted: 01/18/2020] [Indexed: 11/16/2022]
Abstract
Objective: To analyze the prevalence and factors associated with driving under the influence of alcohol (DUIA) in Brazil, according to macroregion. Methods: A cross-sectional study was conducted using data from individuals aged 18 years or older who participated in the 2013 National Health Survey in Brazil. Subjects were selected by probabilistic sampling and interviewed through home visits. Prevalence of DUIA was estimated according to the number of drivers and/or motorcyclists who reported consuming alcohol in the previous 30 days (n = 9537). Poisson regression was used to analyze the factors associated with DUIA to Brazil and in each macroregion of the country. Results: The prevalence of DUIA was 27.5%, 29.4%, 29.6%, 22.9%, and 20.8% in the North, Northeast, Central-West, South, and Southeast macroregions, respectively. The overall prevalence of Brazil was 24.3%. In most macroregions, the main predictors of DUIA were male sex, high educational level, living in outside the capital or metropolitan regions (other regions), and binge drinking in the previous 30 days. Depression was a predictor in Brazil and two macroregions. Conclusion: A high prevalence of DUIA was observed in Brazil, especially in the Central-West, Northeast and, North macro-regions. Factors associated with DUIA can be incorporated to develop effective interventions to reduce this behavior in Brazil.
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Sousa KTD, Marques ES, Levy RB, Azeredo CM. Food consumption and depression among Brazilian adults: results from the Brazilian National Health Survey, 2013. CAD SAUDE PUBLICA 2020; 36:e00245818. [DOI: 10.1590/0102-311x00245818] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 07/08/2019] [Indexed: 12/20/2022] Open
Abstract
Abstract: Our study aimed to evaluate the association between food consumption and depression. We used data from the Brazilian National Health Survey; a cross-sectional study carried out in 2013 among 46,785 Brazilian adults. The exposures were regular consumption (≥ 5 times/week) of the markers of healthy (beans, vegetables, fruits, and natural fruit juices) and unhealthy food (sugar sweetened beverages; sweets and the substitution of lunch or dinner for snacks); and a nutritional score elaborated by combining the frequency of consumption of markers of healthy and unhealthy food, the higher the value, the better the diet. The outcome was depression, assessed through the PHQ-9 questionnaire answered by the participants. Those with PHQ-9 scores greater than or equal to 10 were classified as presenting depression. We performed logistic regression models adjusted for potential confounders. Regular consumption of sweets (OR = 1.53; 95%CI: 1.33-1.76) and regular replacement of meals for snacks (OR = 1.52; 95%CI: 1.21-1.90) were positively associated with depression. Regular consumption of sugar sweetened beverages was positively associated with depression among women (OR = 1.27; 95%CI: 1.10-1.48). Regular consumption of beans was negatively associated with depression (OR = 0.74; 95%CI: 0.65-0.84), consistent for both sexes. Comparing the top quintile of the nutritional score (healthier diet) to the bottom quintile (less healthy) we found a negative association with depression (OR = 0.63; 95%CI: 0.52-0.75). Our results add evidence on a possible role of food consumption in depression; future longitudinal studies should explore the mechanisms of these associations.
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Meneguci J, Meneguci CAG, Moreira MM, Pereira KR, Tribess S, Sasaki JE, Virtuoso Júnior JS. Prevalência de sintomatologia depressiva em idosos brasileiros: uma revisão sistemática com metanálise. JORNAL BRASILEIRO DE PSIQUIATRIA 2019. [DOI: 10.1590/0047-2085000000250] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
RESUMO Objetivo Estimar a prevalência de sintomatologia depressiva em idosos brasileiros residentes na comunidade. Métodos Foi realizada uma revisão sistemática nas bases de dados Medline, SciELO, Web of Science, Scopus e CINAHL, sendo selecionados estudos com idosos brasileiros que identificaram a prevalência de sintomatologia depressiva. De forma independente, dois pesquisadores selecionaram os estudos, extraíram os dados e avaliaram a qualidade metodológica. A metanálise foi realizada para estimar a prevalência de sintomatologia depressiva usando um modelo de efeito aleatório. Resultados Foram identificados 176 artigos e 33 foram incluídos na revisão, que investigaram 34 prevalências, com um total de 39.431 idosos. A distribuição geográfica dos estudos indicou pesquisas em todas as regiões do Brasil. A versão curta da Escala de Depressão Geriátrica foi a mais utilizada. A prevalência estimada de sintomatologia depressiva foi de 21,0% (IC de 95%: 18,0-25,0; I2 = 98,3%). As análises de subgrupos revelaram elevada heterogeneidade em todas as categorias analisadas. A metarregressão não identificou as causas da heterogeneidade. Conclusão Apesar da heterogeneidade entre os estudos analisados, os resultados indicam a necessidade de estratégias de intervenção para reduzir a prevalência de sintomatologia depressiva.
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Kazakovtsev BA, Sidoryuk OV, Zrazhevskaya IA, Ovsyannikov SA. [Regional differences in the incidence of affective disorders]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:10-16. [PMID: 31006785 DOI: 10.17116/jnevro20191191210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AIM To analyze the dynamics of the primary indicator of morbidity of affective psychotic and non-psychotic disorders. MATERIAL AND METHODS The article uses the data of State statistical observations for the period from 2005 to 2015 years. Regional (eight federal districts) primary indicators of diagnosis of mental disorders were subjected to epidemiological analysis in general, schizophrenia and mood disorders were analyzed in more detail. RESULTS AND CONCLUSION The rate of reduction in the incidence of primary psychiatric disorders in this period varied as in Russia in whole as well as in federal districts. It was 22.5% for all mental disorders, 36.0%, for schizophrenia, 50.3% for psychotic forms of mood disorders and 29.6% for non-psychotic disorders, which demonstrated the relatively greater stability of the latter indicator. An analysis of world literature of the last decade shows the convergence of views of foreign and russian researchers on the need for careful clinical assessment of mood disorders in order to form a more differentiated approach to their prevention, diagnosis, treatment and prognostic evaluation.
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Affiliation(s)
- B A Kazakovtsev
- Serbsky National Medical Research Centre for Psychiatry and Narcology, Moscow, Russia
| | - O V Sidoryuk
- Serbsky National Medical Research Centre for Psychiatry and Narcology, Moscow, Russia
| | - I A Zrazhevskaya
- Medical Institute of Russion University of People Friendship, Moscow, Russia
| | - S A Ovsyannikov
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
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Roberts T, Miguel Esponda G, Krupchanka D, Shidhaye R, Patel V, Rathod S. Factors associated with health service utilisation for common mental disorders: a systematic review. BMC Psychiatry 2018; 18:262. [PMID: 30134869 PMCID: PMC6104009 DOI: 10.1186/s12888-018-1837-1] [Citation(s) in RCA: 163] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 08/07/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There is a large treatment gap for common mental disorders (CMD), with wide variation by world region. This review identifies factors associated with formal health service utilisation for CMD in the general adult population, and compares evidence from high-income countries (HIC) with that from low-and-middle-income countries (LMIC). METHODS We searched MEDLINE, PsycINFO, EMBASE and Scopus in May 2016. Eligibility criteria were: published in English, in peer-reviewed journals; using population-based samples; employing standardised CMD measures; measuring use of formal health services for mental health reasons by people with CMD; testing the association between this outcome and any other factor(s). Risk of bias was assessed using the adapted Mixed Methods Appraisal Tool. We synthesised the results using "best fit framework synthesis", with reference to the Andersen socio-behavioural model. RESULTS Fifty two studies met inclusion criteria. 46 (88%) were from HIC. Predisposing factors: There was evidence linking increased likelihood of service use with female gender; Caucasian ethnicity; higher education levels; and being unmarried; although this was not consistent across all studies. Need factors: There was consistent evidence of an association between service utilisation and self-evaluated health status; duration of symptoms; disability; comorbidity; and panic symptoms. Associations with symptom severity were frequently but less consistently reported. Enabling factors: The evidence did not support an association with income or rural residence. Inconsistent evidence was found for associations between unemployment or having health insurance and use of services. There was a lack of research from LMIC and on contextual level factors. CONCLUSION In HIC, failure to seek treatment for CMD is associated with less disabling symptoms and lack of perceived need for healthcare, consistent with suggestions that "treatment gap" statistics over-estimate unmet need for care as perceived by the target population. Economic factors and urban/rural residence appear to have little effect on treatment-seeking rates. Strategies to address potential healthcare inequities for men, ethnic minorities, the young and the elderly in HIC require further evaluation. The generalisability of these findings beyond HIC is limited. Future research should examine factors associated with health service utilisation for CMD in LMIC, and the effect of health systems and neighbourhood factors. TRIAL REGISTRATION PROSPERO registration number: 42016046551 .
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Affiliation(s)
- Tessa Roberts
- Centre for Global Mental Health, Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. .,Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Georgina Miguel Esponda
- 0000 0004 0425 469Xgrid.8991.9Centre for Global Mental Health, Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Dzmitry Krupchanka
- grid.447902.cDepartment of Social Psychiatry, National Institute of Mental Health, Prague, Czech Republic ,0000 0001 2322 4988grid.8591.5Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Rahul Shidhaye
- 0000 0004 1761 0198grid.415361.4Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India ,0000 0001 0481 6099grid.5012.6Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Vikram Patel
- 000000041936754Xgrid.38142.3cDepartment of Global Health and Social Medicine, Harvard Medical School, Boston, USA
| | - Sujit Rathod
- 0000 0004 0425 469Xgrid.8991.9Centre for Global Mental Health, Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
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Gonçalves AMC, Teixeira MTB, Gama JRDA, Lopes CS, Silva GAE, Gamarra CJ, Duque KDCD, Machado MLSM. Prevalência de depressão e fatores associados em mulheres atendidas pela Estratégia de Saúde da Família. JORNAL BRASILEIRO DE PSIQUIATRIA 2018. [DOI: 10.1590/0047-2085000000192] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
RESUMO Objetivo Avaliar a prevalência de depressão e os fatores associados em mulheres de 20 a 59 anos de áreas cobertas pela Estratégia de Saúde da Família de município da Zona da Mata Mineira. Métodos Trata-se de um estudo transversal, com mulheres de 20 a 59 anos cadastradas em duas Unidades de Saúde da Família, que utilizou um questionário contendo variáveis sociodemográficas, apoio social, autoavaliação de estado de saúde, estilo de vida, morbidade e saúde da mulher. O desfecho depressão foi avaliado segundo o Patients Health Questionnaire-9 (PHQ-9). Resultados Das 1.958 mulheres incluídas nesta análise, 28,5% encontram-se na faixa etária entre 30 e 39 anos; 15,4% não concluíram o ensino elementar; 54,5% não trabalham ou nunca trabalharam; 44,2% declararam não ser da raça branca. Fatores associados à ocorrência de depressão na população estudada: possuir baixa escolaridade, trabalhar atualmente e ter doença mental prévia. Como fatores de proteção observaram-se: ser casada ou viver com companheiro, realizar atividades físicas regularmente e relatar autoavaliação positiva de saúde. Conclusão Os resultados deste estudo revelam prevalência de depressão de 19,7% nas mulheres de 20 a 59 anos de áreas cobertas pela Estratégia de Saúde da Família, apontando para a necessidade de um cuidado especial na atenção primária à saúde às mulheres com baixa escolaridade, que trabalham, apresentam doença mental e não praticam exercícios físicos, de modo que se possa reduzir o sofrimento e promover a saúde. Ressalta-se a lacuna na utilização de instrumentos de rastreamento dos casos de depressão na atenção primária.
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Affiliation(s)
| | | | | | - Claudia Souza Lopes
- Universidade Federal da Integração Latino-Americana de Foz de Iguaçu, Brasil
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The association between physical activity and depression among individuals residing in Brazil. Soc Psychiatry Psychiatr Epidemiol 2018; 53:373-383. [PMID: 28889252 DOI: 10.1007/s00127-017-1441-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 08/31/2017] [Indexed: 12/15/2022]
Abstract
PURPOSE There is very limited literature investigating the association between physical activity (PA) and depression in South American countries such as Brazil. The purpose of the current study was to evaluate the prevalence of depression and its association with PA in a very large, representative sample of young adults (ages 18-39 years) (YA), middle-aged adults (ages 40-59 years) (MAA) and older adults (ages ≥ 60 years) (OA) residing in Brazil. METHODS The sample for this cross-sectional study was based on the Brazilian National Health Survey conducted in 2013. The Personal Health Questionnaire depression scale (PHQ-8) was applied to measure current (past 2 weeks) depression as the outcome of interest, and the exposure was self-reported PA for leisure. Multivariable weighted logistic regression models were conducted to investigate the association between PA and depression while adjusting for socio-demographic characteristics and number of health comorbidities among YA, MAA and OA. RESULTS The final study sample size was 59,399 (33,480 females; 25,919 males). After adjusting for the covariates of interest, the lack of PA for leisure was associated with a significant increase in depression only among males (YA: OR 1.45, 95% CI 1.02-2.06; MAA: OR 2.38, 95% CI 1.40-4.03; OA: OR 5.35, 95% CI 2.14-13.37). There was no significant association between PA for leisure and depression among females of all age groups. CONCLUSIONS Although PA for leisure is not associated with depression among Brazilian females, the obtained results suggest that this association is significant among Brazilian males, who may be able to benefit from PA for leisure to reduce their symptoms of depression.
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Kilbourne AM, Beck K, Spaeth-Rublee B, Ramanuj P, O'Brien RW, Tomoyasu N, Pincus HA. Measuring and improving the quality of mental health care: a global perspective. World Psychiatry 2018; 17:30-38. [PMID: 29352529 PMCID: PMC5775149 DOI: 10.1002/wps.20482] [Citation(s) in RCA: 190] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Mental disorders are common worldwide, yet the quality of care for these disorders has not increased to the same extent as that for physical conditions. In this paper, we present a framework for promoting quality measurement as a tool for improving quality of mental health care. We identify key barriers to this effort, including lack of standardized information technology-based data sources, limited scientific evidence for mental health quality measures, lack of provider training and support, and cultural barriers to integrating mental health care within general health environments. We describe several innovations that are underway worldwide which can mitigate these barriers. Based on these experiences, we offer several recommendations for improving quality of mental health care. Health care payers and providers will need a portfolio of validated measures of patient-centered outcomes across a spectrum of conditions. Common data elements will have to be developed and embedded within existing electronic health records and other information technology tools. Mental health outcomes will need to be assessed more routinely, and measurement-based care should become part of the overall culture of the mental health care system. Health care systems will need a valid way to stratify quality measures, in order to address potential gaps among subpopulations and identify groups in most need of quality improvement. Much more attention should be devoted to workforce training in and capacity for quality improvement. The field of mental health quality improvement is a team sport, requiring coordination across different providers, involvement of consumer advocates, and leveraging of resources and incentives from health care payers and systems.
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Affiliation(s)
- Amy M Kilbourne
- Health Services Research and Development Service, Veterans Health Administration, US Department of Veterans Affairs, Washington, DC, USA
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Kathryn Beck
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Brigitta Spaeth-Rublee
- Department of Behavioral Health Services and Policy Research, New York State Psychiatric Institute, New York, NY, USA
| | - Parashar Ramanuj
- RAND Europe, Cambridge, UK
- Royal National Orthopaedic Hospital, Stanmore, UK
| | - Robert W O'Brien
- Health Services Research and Development Service, Veterans Health Administration, US Department of Veterans Affairs, Washington, DC, USA
| | - Naomi Tomoyasu
- Health Services Research and Development Service, Veterans Health Administration, US Department of Veterans Affairs, Washington, DC, USA
| | - Harold Alan Pincus
- Department of Psychiatry and Irving Institute for Clinical and Translational Research, Columbia University and New York-Presbyterian Hospital, New York, NY, USA
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Silva MT, Caicedo Roa M, Martins SS, da Silva ATC, Galvao TF. Prevalence and correlates of depressive symptoms among adults living in the Amazon, Brazil: A population-based study. J Affect Disord 2017; 222:162-168. [PMID: 28709023 DOI: 10.1016/j.jad.2017.06.053] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 06/02/2017] [Accepted: 06/23/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Depression is an affective disorder and one of the main contributors to the burden of disease worldwide. Our purpose is to estimate the prevalence of depressive symptoms and associated factors in the population of the Manaus Metropolitan Region. METHODS We conducted a population-based, cross-sectional study with a probabilistic three-phase sampling in 2015, based on a previously calculated sample size. Adults living in Manaus and seven inner cities of the metropolitan region were surveyed for depressive symptoms using the Patient Health Questionnaire (PHQ-9) and a cutoff score of ≥ 9. We performed a Poisson regression with robust variance using a hierarchical approach to calculate the prevalence ratio (PR) of depression and 95% confidence intervals (CIs). RESULTS Among 4001 participants (response rate 76%), the prevalence of current depressive symptoms was 7% (95% CI: 6-8%). Depressive symptoms were more frequent in inhabitants of Manaus than in those from the countryside (PR = 6.13, 95% CI: 2.91-12.91); in women than in men (PR = 2.55, 95% CI: 1.96-3.33); in indigenous than in white people (PR = 2.56, 95% CI: 1.24-5.30); and in those with hypertension (PR = 1.47, 95% CI: 1.13-1.92), cardiac disease (PR = 1.62, 95% CI: 1.12-2.33), and poor health status (fair: PR = 5.10, 95% CI: 2.50-10.37; bad: PR = 10.27, 95% CI: 4.92-21.44 very bad: PR = 21.14, CI 95%: 10.16-43.99). High school education (PR = 0.55, 95% CI: 0.32-0.95) and middle class economic status (PR = 0.33, 95% CI: 0.12-0.89) were protective factors. LIMITATIONS Limitations include the lack of measurement of physical activity, religious beliefs, leisure time, and use of alcohol and other drugs since these factors can affect depression and health status. CONCLUSION Seven out of every 100 adults from the Manaus Metropolitan Region have depressive symptoms. This rate is higher in women, individuals living in Manaus, indigenous people, people with hypertension or chronic cardiac disease, and those with a poor health status.
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Affiliation(s)
- Marcus T Silva
- Faculty of Medicine, Federal University of Amazonas (UFAM), Rua Afonso Pena, 1053, Manaus, AM 69020-160, Brazil.
| | - Mónica Caicedo Roa
- Faculty of Medicine, Clinical Research Institute, National University of Colombia (UNAL), Bogotá, Colombia
| | - Silvia S Martins
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Andréa Tenório Correia da Silva
- Santa Marcelina Faculty of Medicine, University of São Paulo, Sao Paulo, SP, Brazil; Department of Preventive Medicine, University of São Paulo, Sao Paulo, SP, Brazil
| | - Tais F Galvao
- Faculty of Pharmaceutical Sciences, University of Campinas (Unicamp), São Paulo 13083-871, Brazil
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Bonadiman CSC, Passos VMDA, Mooney M, Naghavi M, Melo APS. A carga dos transtornos mentais e decorrentes do uso de substâncias psicoativas no Brasil: Estudo de Carga Global de Doença, 1990 e 2015. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2017; 20Suppl 01:191-204. [DOI: 10.1590/1980-5497201700050016] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 02/20/2017] [Indexed: 11/22/2022] Open
Abstract
RESUMO: Introdução: Os transtornos mentais e decorrentes do uso de substâncias psicoativas (TM) são altamente prevalentes, gerando elevado custo social e econômico. Objetivo: Descrever a carga dos TM no Brasil e Unidades Federativas (UFs), em 1990 e 2015. Métodos: Estudo descritivo da carga de doença dos TM, por meio de estimativas padronizadas por idade do Global Burden of Disease Study 2015: anos de vida perdidos por morte prematura (YLL); anos vividos com incapacidade (YLD); e anos de vida perdidos por morte ou incapacidade (DALY=YLL+YLD). Resultados: No Brasil, apesar da baixa taxa de mortalidade, observa-se alta carga para os TM desde 1990, com elevados YLD. Em 2015, esses transtornos foram responsáveis por 9,5% do total de DALY, ocupando a 3ª e a 1ª posições na classificação de DALY e YLD, respectivamente, com destaque para os transtornos depressivos e de ansiedade. Os transtornos decorrentes do uso de drogas apresentaram a maior elevação das taxas de DALY entre 1990 e 2015 (37,1%). A maior proporção de DALY ocorreu na idade adulta e no sexo feminino. Não houve diferenças substanciais na carga dos TM entre as UFs. Conclusão: Apesar da baixa mortalidade, os TM são altamente incapacitantes, indicando necessidade de ações preventivas e protetivas, principalmente na atenção primária em saúde. A homogeneidade das estimativas em todas as UFs, obtidas a partir de estudos realizados majoritariamente nas regiões Sul e Sudeste, provavelmente não reflete a realidade do Brasil, e indica necessidade de estudos em todas as regiões do país.
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Affiliation(s)
| | | | - Meghan Mooney
- Institute for Health Metrics and Evaluation, Estados Unidos
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, Estados Unidos
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