A cross-sectional study to compare levels of psychiatric morbidity between young people and adults exposed to violence in a large urban center

Prevalence of depressive disorder in the adult population of Latin America: a systematic review and meta-analysis

Background

Depressive disorder is one of the leading causes of disability worldwide; however its prevalence and association with inequality and crime is poorly characterised in Latin America. This study aimed to: i. systematically review population-based studies of prevalence of ICD/DSM depressive disorder in Latin America, ii. report pooled regional, country, and sex-specific prevalence estimates, and iii. test its association with four country-level development indicators: human development (HDI), income (Gini) and gender inequality (GII), and intentional homicide rate (IHR).

Methods

We conducted a systematic review and meta-analysis of population-based studies reporting primary data on the prevalence of ICD/DSM depressive disorder in Latin America from 1990 to 2023, irrespective of language. We searched PubMed, PsycINFO, Cochrane Library, SciELO (regional database), LILAC (regional database), and available grey literature. Study quality was assessed using JBI's critical appraisal tools. We generated pooled estimates using random-effects meta-analysis; heterogeneity was assessed using the I2 statistic. Meta-regression analyses were used to test associations of depression prevalence with indicators of inequality and human development. The study was registered with PROSPERO (CRD42019143054).

Findings

Using data from 40 studies in Latin America, lifetime, 12-month, and current prevalence of ICD/DSM depressive disorder were calculated at 12.58% (95% CI 11.00%-14.16%); 5.30% (4.55-6.06%), and 3.12% (2.22-4.03), respectively. Heterogeneity was high across lifetime, 12-month, and current prevalence, sex, and countries. 12-month and current prevalence was associated with higher Gini and GII, 12-month prevalence with lower HDI, and current prevalence with higher IHR.

Interpretation

We found a high prevalence of ICD/DSM depressive disorders in Latin America, and a statistically significant association with inequality and development indicators. The high heterogeneity found across prevalence periods and the major gaps in country representation underscore the need to escalate efforts to improve mental health access and research capabilities in Latin America. Systematic, comparable prevalence estimates would inform more effective decision-making in the region.

Funding

Pfizer Independent Medical Education Grant.

Robbery Victimization in Early Adulthood, and Depression and Anxiety at Age 30 Years: Results From the 1982 Pelotas (Brazil) Birth Cohort Study

Robbery is one of the most common urban crimes, but little is known about its relationship with mental disorders in young adults. This study aimed to assess the relationship between robbery victimization and Major Depressive Disorder (MDD), Generalized Anxiety Disorder (GAD) and comorbidity between MDD and GAD at 30 years of age. A birth cohort study has followed all children born in the city of Pelotas, southern Brazil, since 1982. At ages 23 and 30 years, participants were interviewed and asked about lifetime and recent experiences of robbery. Covariates were measured in interviews between birth and age 30 years. MDD and GAD were measured using the MINI-International Neuropsychiatric Interview. Adjusted prevalence ratio (aPR) and corresponding 95% confidence interval (CI) for associations between robbery and mental disorders were calculated using Poisson regression with robust standard error. Of 3,701 cohort members interviewed at age 30 years, 42% reported robbery victimization during their lifetime. Victimization across three periods (lifetime, past 10 years, past 12 months) was associated with increased occurrence of MDD, GAD, as well as the MDD and GAD comorbidity. The strongest associations were found to robbery occurring in the previous 12 months with the MDD and GAD comorbidity, both for burglary at home (aPR 2.52; 95% CI 1.52-4.22) or community family victimization (aPR 2.10; 95% CI 1.34-3.27). These findings highlight the importance of community violence for mental health in young adulthood, and the need for public policies to prevent violence as well as support services for victims to mitigate its adverse health consequences.

Local understandings of PTSD and complex PTSD among health professionals working with adolescents in violent neighbourhoods of São Paulo city, Brazil

BACKGROUND

Adolescents in low-resource urban settings in Brazil are often exposed to high levels of trauma that can result in post-traumatic stress disorder (PTSD). However, preliminary evidence indicates that PTSD tends to be under-reported in Brazilian health services, despite the high prevalence of trauma. Additionally, little is known about the perceived applicability among clinicians of the new ICD-11 diagnosis of complex PTSD (CPTSD), despite its potential relevance for contexts of chronic trauma. The current study investigated local understandings of PTSD and CPTSD among health professionals working with adolescents in violent neighbourhoods of São Paulo city.

METHODS

Semi-structured interviews were conducted with 58 health professionals working at both the primary care and specialized mental health levels in two areas of São Paulo city with high levels of community violence.

RESULTS

Most participants knew about PTSD, but most did not know about CPTSD. There were mixed views concerning the commonality of PTSD among adolescents exposed to community violence. Many participants reported having no experience working with patients with the PTSD diagnosis. According to some, community violence was normalized by adolescents and health professionals, and did not result in PTSD. Others highlighted how they did not use psychiatric diagnoses in their practice, had critical perspectives towards psychiatric diagnoses and/or PTSD, or simply knew little about PTSD. Furthermore, many highlighted how the chronic nature of multiple traumas experienced by adolescents often resulted in complex clinical presentations characterised by many symptoms beyond PTSD. The diagnosis of CPTSD was considered appropriate to the context by many participants as it captured the complex traumatic histories and symptom presentations of adolescents exposed to community violence in Brazil.

CONCLUSIONS

These findings have important implications for the assessment and treatment of mental health among adolescents exposed to community violence in Brazil.

Rumination, Posttraumatic Stress Disorder Symptoms, and Posttraumatic Growth Among Wenchuan Earthquake Adult Survivors: A Developmental Perspective

This study examined the long-term effects of the Wenchuan earthquake among adult survivors. Specifically, it explored the role of perceived social support (PSS) in the relationship between rumination and posttraumatic growth (PTG) and posttraumatic stress disorder (PTSD) symptoms. Data were collected from March to July 2020 using a youth survivor sample (n = 476) of the 2008 Wenchuan earthquake. Participants were divided into three groups depending on their age when the quake occurred: 6-11 years (n = 227), 12-15 years (n = 83), 16-19 years (n = 166). The results indicated that long-term PTG and PTSD symptom levels varied by age group. Both intrusive and deliberate ruminations had a significant effect on PTG as well as PTSD symptoms. PSS played a mediating role between rumination and PTG, and the mediation mechanisms varied by age group (developmental stages). Moderated analyses revealed that PSS from significant others significantly buffered the indirect effect of rumination on PTSD symptoms. Our findings demonstrated the universal nature of traumatic events encountered during childhood and adolescence development and underscore the importance of examining the developmental context of PTG in investigations on traumatic experiences and their consequences.

Pilot Randomized Control Trial: Efficacy of a Group-Based Psychosocial Program for Youth with PTSD in the Brazilian Favelas

The study aimed to evaluate Teaching Recovery Techniques (TRT) delivered to Brazilian youth who experienced drug violence in one Favela. Thirty children, 8 to 14 years, were randomly assigned to TRT (n = 14) or to a treatment as usual group (n = 16) involving boxing/martial arts. Youth received five 90-min sessions over successive weeks. Standardized measures assessed Posttraumatic Stress and Depression at 2 weeks pre and post-test. An exploratory assessment of posttraumatic growth was also utilized. An interview with group leaders explored perceptions of delivering TRT within the favela. Medium effect sizes were found for PTSD and Depression, and a small effect size for posttraumatic growth. Group leaders emphasized understanding the favela context for program adaptation. In conclusion, TRT was found to be effective for children with PTSD and Depression who experienced drug violence in a Brazilian favela. TRT is recommended for future delivery. Larger scale RCTs are needed in Brazilian favelas.

A mortalidade entre adolescentes egressos do sistema penal

Resumo O objetivo deste artigo é analisar as causas de internações da FASE do Estado do Rio Grande do Sul e a sua relação com a mortalidade de adolescentes egressos entre os anos de 2002 a 2014. Estudo observacional realizado com o banco de dados de adolescentes privados de liberdade nas unidades da FASE-RS de Porto Alegre, desligados nos anos de 2002 a 2012 (n = 8290). Informações sobre data de desligamento, ato infracional, tempo de internação e variáveis biológicas foram obtidas de banco de dados. Essa amostra foi comparada com o Sistema de Verificação de Óbitos da Secretaria Estadual de Saúde para analisar a mortalidade entre os anos de 2002 e 2014. Os adolescentes foram internados predominantemente por atos infracionais de cunho patrimonial e ligados a entorpecentes, os quais sofreram um aumento de aproximadamente 700% no período. O desfecho óbito associou-se (p < 0,001) às variáveis gênero masculino e número de entradas (≥ 3). Essa amostra apresentou alta taxa de mortalidade sendo a principal causa homicídio. Os achados evidenciam o alto grau de vulnerabilidade psicossocial dos egressos do sistema penal juvenil de internação. Nota-se uma associação entre crimes de baixo poder ofensivo e altas taxas de mortalidade pós-liberdade.

Cues for different diagnostic patterns of interpersonal violence in a psychiatric sample: an observational study

BACKGROUND

Interpersonal violence has increased as a health concern, especially in psychiatry practice, over the last decades. Nevertheless, most patients with stable mental disorders do not present an increased risk of violence, and mental disorder is not a necessary or sufficient cause of violent behaviours. People with mental disorders endorse more often a number of risk factors for violence that could confound this association, such as young age and male gender. The aim of this study was to investigate the effect of age, gender, and diagnosis on reported levels of interpersonal violence in a sample of people with severe mental illness.

METHODS

The sample was composed of 160 inpatients: 73 with a psychosis within the schizophrenia spectrum, 53 with a mood disorder and 34 with a personality disorder. All patients enrolled in the study were assessed for experiences of victimization and perpetration of interpersonal violence using the Karolinska Interpersonal Violence Scale interview. Demographic variables were also collected.

RESULTS

Both violence perpetration and victimization negatively correlated with age. Compared to males, females were exposed to higher degree of victimization in childhood and adulthood, whereas males were more involved in the perpetration of violence in childhood. Personality disorders were associated with higher levels of interpersonal violence, both perpetration and victimization; an interaction effect of gender and diagnosis was also observed for violence perpetration in adulthood. Distinct patterns of interpersonal violence did emerge for the diagnostic groups with mood disorder showing a victimization pattern, personality disorders a perpetration pattern and psychoses less defined patterns.

CONCLUSIONS

The main finding is that psychotic disorders, mood disorders and personality disorders have different patterns of violent experiences interacting with age and gender. This study offers a better understanding of how gender and age could affect violent behaviours. Moreover, study findings may increase the comprehension of the reason why some mental disorders, compared to others, are more associated with the risk of victimization or perpetration of violence. These patterns could have pathophysiological or pathoplastic meaning addressing clinical and diagnostic trajectories and they could interact with other intervening risk factors.

Depression in Youth Exposed to Disasters, Terrorism and Political Violence

PURPOSE OF REVIEW

This paper reviews recent research on the depression in young people following exposure to catastrophic stresses such as disasters, terrorism and political violence.

RECENT FINDINGS

Depression is one of the commonest outcomes following mass trauma, for all ages including children and adolescents. Recent articles continue to report high prevalence of depression which often continues for years. It is often comorbid with other psychiatric disorders, especially PTSD. Post-traumatic depression in children and adolescence affects purpose of life, impairs scholastic achievements, increases suicidality and has extensive comorbidity. Besides the trauma, individual constructs, personality factors, social support, exposure to other traumatic events are some of the predicting factors. Biological and genetic basis of post-traumatic depression has been reported. Studies suggest some benefit to psychotherapeutic interventions such as trauma-focussed cognitive behavioural therapy and web-based therapy. A considerable proportion of youths develop depression following mass traumatic events. More research is required regarding the effectiveness of interventions in this population.

Exposure to potentially traumatic events in young Swiss men: associations with socio-demographics and mental health outcomes (alcohol use disorder, major depression and suicide attempts)

Background and objective: The aims of this study were to estimate the lifetime and 12-month prevalence of exposure to potentially traumatic events (PTEs) in young men in Switzerland and to assess factors and mental health outcomes associated with such events. Method: Data were drawn from the Cohort Study on Substance Use Risk Factors (C-SURF), encompassing 5,223 young men. Exposure to PTEs was assessed using the Post-traumatic Diagnostic Scale (PDS), Trauma History Questionnaire (THQ) and Life Event Checklist (LEC). Results: Lifetime prevalence of PTEs was 59.4%, with 37.3% reporting multiple types of events. Twelve-month prevalence was 31.2%, with 12.7% reporting multiple types of events. Low education level of participants, high maternal education, family affluence below average, and not living with biological parents were associated with a higher risk of having experienced one or more PTEs in one's lifetime. Low education level of participants and high maternal education were also related to exposure to one or more PTEs over the past 12 months. Logistic regression analyses demonstrated that PTE exposure was directly associated with all assessed mental health outcomes. The strongest relationship was found between exposure to multiple types of PTEs and suicide attempts (adjusted OR 4.9 [95% CI: 2.9-8.4]). Conclusions: These results indicate that having experienced one or multiple types of PTEs is common in Swiss young men. Efforts should be intensified to reduce exposure to PTEs and prevent and treat resulting problematic mental health outcomes in young adults.

Self-rated health and perceived violence in the neighborhood is heterogeneous between young women and men

Background

Self-rated health (SRH) is the general perception of an individual’s own health and a key indicator to measure health in population-based studies. Few studies have examined the association between perceived urban violence and SRH among young adults. There were an estimated 475,000 deaths in 2012 as a result of homicide on the world. Sixty percent of these deaths occurred among males aged 15–44 years, making homicide the third leading cause of death for this population group. This study aimed to determine and quantify the association between sex-specific perception of violence in the neighborhood and SRH among young adults.

Methods

Participants included 955 young adults (18–29 years) residing in Belo Horizonte, Minas Gerais, Brazil between 2008 and 2009. Logistic regression analysis was used to estimate the strength of the associations. The perceived urban violence score was constructed from variables that assessed the respondents’ insecurity and perception of fear and danger of suffering some form of violence in the neighborhood using exploratory factor analysis.

Results

18,3% of respondents rated their health as fair/ poor/very poor. Among women, fair/ poor/very poor SRH was associated with age between 25 and 29 years, low socioeconomic status score, being dissatisfied with weight, not exercising regularly, not having a healthy diet, and having some chronic disease. Men who rated their health as fair/poor/very poor more frequently smoked, were dissatisfied with their weight, did not exercise regularly, consumed fewer fruits and vegetables, and had some chronic disease compared to men who rated their health as very good/good. In the final model, after adjusting for confounding variables, perceived violence in the neighborhood was associated with poor SRH in young women only (OR = 1.52; 95% CI: 1.04–2.21).

Conclusion

The results indicate that public and health policies should implement interventions on the neighborhood physical and social environment to improve the perception of safety and have a positive impact on people’s health, especially women.