A carga dos transtornos mentais e decorrentes do uso de substâncias psicoativas no Brasil: Estudo de Carga Global de Doença, 1990 e 2015

Impact of COVID-19 on Anxiety and Depression - Biopsychosocial Factors

Anxiety and depression are prevalent mental disorders around the world. The etiology of both diseases is multifactorial, involving biological and psychological issues. The COVID-19 pandemic settled in 2020 and culminated in several changes in the routine of individuals around the world, affecting mental health. People infected with COVID-19 are at greater risk of developing anxiety and depression, and individuals previously affected by these disorders have worsened the condition. In addition, individuals diagnosed with anxiety or depression before being affected by COVID-19 developed the severe illness at higher rates than individuals without mental disorders. This harmful cycle involves several mechanisms, including systemic hyper-inflammation and neuroinflammation. Furthermore, the context of the pandemic and some previous psychosocial factors can aggravate or trigger anxiety and depression. Disorders are also risks for a more severe picture of COVID-19. This review discusses research on a scientific basis, which brings evidence on biopsychosocial factors from COVID-19 and the context of the pandemic involved in anxiety and depression disorders.

Evaluation of mobile applications focused on the care of patients with anxiety disorders: A systematic review in app stores in Brazil

OBJECTIVE

To identify and evaluate the quality of mobile apps available in Brazil focused on the care of patients with anxiety disorders.

METHODS

A comprehensive search was conducted until October 2021 on Play Store (Android) and Apple Store (iOS) in Brazil, using the terms "anxiety," "phobia," "panic attack," and "social phobia." Two independent authors identified the apps and performed data extraction and quality assessment using the Mobile App Rating Scale (MARS). Pearson's correlation was used to analyze the relationship between user star rating and the quality defined by the MARS instrument.

RESULTS

A total of 3,278 potential apps were identified, of which 71 fully met the eligibility criteria. Most apps were made available on the Play Store (91.74%), in English (69.01%), and updated in the last two years (90.14%). Approximately half of the apps (50.70%) did not inform the developer's country and most of them did not report the user star rating (70.42%). The target population was indicated as free by most apps (85.92%), with generalized anxiety disorder being the most addressed disorder (74.65%), followed by panic disorder (33.80%). The three main purposes of the apps were education (83.10%), self-assessment (38.03%), and meditation/breathing (32.39%). Only 31 apps (43.66%) had acceptable quality (above 3.0) and the average total MARS quality score of 2.93 (2.20 to 3.90), with the functionality section receiving the highest score (3.90) and the lowest scoring sections being engagement (2.16). The apps that were rated stars by users (29.58%) showed a negative Pearson correlation (ρ = -0.100), evidencing a difference in the user's evaluation and that performed using the MARS instrument.

CONCLUSION

Gaps in the quality of apps focused on the care of patients with anxiety disorders were evidenced since most were classified as having low quality through the MARS instrument. Thus, users are recommended to use these apps with caution.

Economic burden of depression in Brazil: a cost-of-illness study based on productivity losses and healthcare costs between 2010 to 2018

BACKGROUND

Depression is disabling disorder and cause functional impairments, and high costs for the health and social security system.

OBJECTIVE

The direct and indirect costs of depression from the societal perspective were estimated for the period 2010 to 2018.

METHODS

This cost-of-illness study in adults is based on prevalence, with a top-down approach, from the societal perspective. Direct (hospital and outpatient) and indirect (absenteeism) costs were included. Data were extracted from the Hospital and Outpatient Information Systems and the National Social Security Institute.

RESULTS

The cost of depression was Int$ 2,288,511,607.39 in the analyzed period, with an average annual cost of Int$ 254,279,067.49. From 2014 to 2018, had a sharp and persistent decrease in the cost of depression (-44.24%), mainly in indirect costs (-55.83%). In the period investigated, indirect costs represented 74.85% of the total cost. Over time, outpatient surpassed hospital cost. In 2017 and 2018, outpatient costs represented 43.22% and 39.57% of total costs. In all the years and cost components analyzed, women predominated.

CONCLUSIONS

Depression is a disease with a high economic burden for the healthcare system. Investments are still needed, such as higher coverage of services, multidisciplinary teams, and training of health professionals for psychosocial care.

Prevalence of self-reported depression in Brazil: National Health Survey 2019 and 2013

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.

Contingent stimulus delivery assay for zebrafish reveals a role for CCSER1 in alcohol preference

Alcohol use disorders are complex, multifactorial phenomena with a large footprint within the global burden of diseases. Here, we report the development of an accessible, two-choice self-administration zebrafish assay (SAZA) to study the neurobiology of addiction. Using this assay, we first demonstrated that, although zebrafish avoid higher concentrations of alcohol, they are attracted to low concentrations. Pre-exposure to alcohol did not change this relative preference, but acute exposure to an alcohol deterrent approved for human use decreased alcohol self-administration. A pigment mutant used in whole-brain imaging studies displayed a similar relative alcohol preference profile; however, mutants in CCSER1, a gene associated with alcohol dependence in human genetic studies, showed a reversal in relative preference. The presence of a biphasic response (hormesis) in zebrafish validated a key aspect of vertebrate responses to alcohol. SAZA adds a new dimension for discovering novel alcohol deterrents and studying the neurogenetics of addiction using the zebrafish.

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

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.

The burden of mental disorders attributable by cocaine use: Global Burden of Diseases Study in Brazil, 1990 and 2019

INTRODUCTION

Brazil is an important consumer market for cocaine. However, the consequences of this consumption and the pattern of distribution of the estimates are still poorly studied in the Brazilian states. The Global Burden of Disease study - 2019 (GBD-2019) has enabled us to describe and analyze indicators of mental disorders (MD) attributable by cocaine use in Brazil and its states, in 1990 and 2019.

METHODS

A descriptive study of the burden of cocaine use disorders, using prevalence, age-standardized mortality rate (ASMR), years of life lost (YLL) due to premature death, years lived with disabilities (YLD), and disability adjusted life years (DALY), which accounts for YLL+YLD.

RESULTS

Brazil ranks 8th as DALYs due to cocaine use disorder in the world (42.83/100.000; 95% uncertainty intervals [95% UI]: 35.28 to 61.43). Significant increases have occurred in the age-standardized rate prevalence (ASRP), ASMR, DALY, YLD, and YLL, in Brazil and its states, between 1990 and 2019. The ASRP in 2019 was 2.7-fold higher for men (278.60/100.000; 95% UI: 208.20 to 374.39) in comparison to women (104.01/100.000; 95% UI: 76.70 to 143.02). There is a predominance of YLD in the composition of DALYs; however, the YLL had the biggest increases between 1990 and 2019.

CONCLUSIONS

The high rate of DALYs and the increase in mortality rates show the need to scale up effective interventions to prevent and reduce the burden of disease attributable to cocaine use disorder, which is a preventable cause of death and disability.

Global burden of mental illness in agents fighting endemics

Abstract: Mental disorders are the main cause of the young and economically active population worldwide and in Brazil to live with disabilities, being an important public health problem nowadays. The objective was to estimate the burden of mental disorders among professionals working to combat endemic diseases in a state in northeastern Brazil. Medical records of workers linked to the Brazilian Ministry of Health in Ceará State and fighting endemic diseases were surveyed and, from this, a historical cohort was made. The individual quantification of absenteeism by mental disorders (ICD F-chapter referring to mental disorders) was conducted considering a period of about 35 years, from admission (the 1980s) to December 2017. The global burden of disease was measured by the YLD indicator (years lost to disability). Considering that no deaths due to mental disorders were observed, the YLL indicator (years of life lost) was composed. The high mental disorders burden in this group of workers stands out, whose mood disorders, including depression, conferred a YLD equal to 18.6. This represents just over 18 years of work lived with a disability. Our findings reinforce the need to implement surveillance and health promotion actions in workers to promote effective interventions capable of contributing to the reduction of morbidity in workers and economically active people.

Why does mental health care not follow the structuring of primary care?

OBJECTIVE:

To verify if primary care teams with better structured primary health care (PHC) attributes could offer better mental health (MH) care.

METHODS:

Cross-sectional study based on data from the external evaluation of the second cycle of the Programa de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB - Access and Quality Improvement of Primary Care Program), involving 31,587 primary care teams, between 2013 and 2014. Two typologies were built: quality of mental health care (dependent variable) and PHC structuring according to essential attributes (independent variable). We identified some contents for the construction of the mental health typology (module II of the PMAQ) and performed sums of questions for the categorization of indices. The Delphi technique rendered consensus in four rounds endorsed by experts, following the attributes of PHC structure. Multinomial logistic regression analyses verified the association between the typologies and identified which attribute most contributed to the quality of mental health care.

RESULTS:

We found out that 29.2% of the teams are at low levels of quality in assistance to MH, while 7.5% of the teams have a low level of structuring the PHC according to essential attributes. Regional differences are maintained, both for the structuring of the PHC and for the quality of mental health care. There was a greater chance of providing care in MH with better quality when the PHC is better structured at a high level (OR = 14.74) and at a medium level (OR = 2.193). A high level of completeness is associated with a high level of Quality of Care in MH (OR = 3.21).

CONCLUSION:

results indicate a predominance of low levels of quality in mental health care, out of step with the process of PHC structuring and its essential attributes.

Estimation of Years Lived with Disability Using a Prevalence-Based Approach: Application to Major Psychiatric Disease in Korea

To help develop policies concerning the prevention of psychiatric disease in Korea, we reviewed the literature on this topic in different countries and used a prevalence-based approach to estimate the years lived with disability (YLDs) in Korean patients with major psychiatric diseases. We calculated YLDs by extracting data on the number of patients with mild, moderate, and severe cases of schizophrenia, bipolar disorder, and major depressive disorder, as classified by International Statistical Classification of Disease (ICD) codes. YLDs were highest for patients with major depressive disorder (1190.6; 73.9%), schizophrenia (303.3; 18.8%) and bipolar disorder (117.9; 7.3%). Men had higher YLDs for schizophrenia, 2502 (20-24 years); bipolar disorder, 477 (40-44 years); and major depressive disorder, 2034 (75-79 years). Women had higher YLDs for schizophrenia, 484 (45-49 years); bipolar disorder, 214 (≥80 years); and major depressive disorder, 3541 (75-79 years). The prevalence-based approach and severity distribution is useful for estimating long-term psychiatric disease burden and YLDs. However, YLD-estimation studies must compensate for the shortcomings of the ICD-10 by referencing the Diagnostic and Statistical Manual of Mental Disorders 5th edition, as well as updating the disability weight score according to disease severity.

[Mental health and organizational quality of primary healthcare services in Brazil]

The study aimed to assess the quality of care for persons with mental health distress in primary healthcare services in Brazil and the association with organizational structure variables. This evaluative study used data from the Brazilian National Program to Improve Acess and Quality in Primary Care (PMAQ-AB), collected in 2018. The study excluded teams that reported not performing this type of care. The sum of the 13 selected mental health indicators produced a score that was classified in three groups of quality: G1 (0 to 5 points - lower quality), G2 (6 to 9 points - medium quality), and G3 (10 to 13 points - higher quality), and the results were associated with nine organizational context variables favoring the teams' permanence in the respective quality groups. The study evaluated 36,384 teams, located in 5,026 municipalities (counties). The score ranged from 1 to 13 points (G1 = 9.7%; G2 = 25.1%; G3 = 65.2%). Having an environment favorable to dispensing medicines and privacy during patient consultations; existence of a medical specialist, psychologist, and pharmacist; inter-consultation with the Expanded Family Health Care Centers (NASF) and Centers for Psychosocial Care (CAPS); and weekly or biweekly team meetings, were more frequent in the teams with higher quality (p < 0.001). In conclusion, structural conditions related to infrastructure and availability of healthcare workers, as well as inter-consultation and spaces for reflection to discuss the (re)organization of work processes in care for patients with mental health distress are factors that influence the quality of care, requiring attention, especially given recent political setbacks.

Functional Disability in Patients with Mood Disorders at St Paul's Hospital Psychiatry Clinic, Addis Ababa, Ethiopia, 2019

Background

Functional disability is defined as limitations in performing socially defined roles and tasks expected within a sociocultural and physical environment. Functionality is a result of good mental health care. This study aimed to assess the magnitude and determinants of functional disability among patients with a mood disorders treated at St Paul's Hospital outpatient psychiatry clinic, Addis Ababa, Ethiopia in 2019.

Methods

This was a cross-sectional study. We used consecutive sampling to select respondents. Data were collected through face-to-face interviews using the 12-item World Health Organization Disability Assessment Schedule version 2.0. Data were entered into EpiData 3.1 and exported to SPSS 22.0 for analysis. Linear regression analysis was used to identify significant variables associated with outcomes.

Results

This study enrolled 235 respondents with a 100% nonresponse rate, and 62.5% were diagnosed with major depressive disorder. Mean disability score was 30.2%±32.4%. Nearly a quarter of respondents had had difficulties every day with day-to-day activity for the past 30 days. Current level of improvement (no change, β=10.5, 95% CI 3.85-17.2), relapse (β=6.15, 95% CI 1.34-10.9) and self-stigma (β=4.36, 95% CI 1.39-7.33) were strong predictors of disability score (P<0.05).

Conclusion

This study found a mean disability score of 30.2%. Current level of improvement and self-stigma were variables associated with disability, so working with stakeholders to focus on patients' clinical improvement from their illness and self-stigma will be vital to enhance their functionality.

Use of psychotropic drugs among workers on leave due to mental disorders

OBJECTIVE

To describe the use of psychotropic drugs among civil servants with registered absenteeism due to mental disorders, and to investigate associations with duration of leave of absence.

METHODS

A cross-sectional study with civil servants on leave of absence due to mental disorders, between January and December 2017. Demographic, occupational and clinical variables were extracted from secondary data. Non-parametric tests were used to investigate correlations between use of psychotropic drugs and leave duration. Cluster analysis was used to investigate associations between occupational characteristics and illness profile.

RESULTS

Antidepressants were the most commonly used drugs (82.9%). Central tendency values for days on leave differed according to the number of psychotropic drugs used. In cluster analysis, a particular cluster (servants of intermediate age group and work experience - mean of 46 years and 15 years, respectively) stood out regarding use of antidepressants, severity of depression and frequency and duration of leave of absence.

CONCLUSION

Leave of absence due to mental disorders was associated with higher rates of psychotropic drug use. The group of servants identified in this study may be a primary target for health promotion, prevention and recovery actions at the organization.

Psychiatric hospitalizations by the Unified Health System in Brazil between 2000 and 2014

OBJECTIVE

To characterize the profile of patients hospitalized for mental and behavioral disorders by the Unified Health System (SUS) in Brazil between 2000 and 2014, and to verify how aspects of the new mental health policy influenced the rate of hospitalized patients in that period.

METHODS

Non-concurrent prospective cohort study using secondary data from inpatients with a primary diagnosis of mental and behavioral disorders between 01/01/2000 and 12/31/2014. Sociodemographic, clinical, and hospital characteristics variables were selected. Overall rates of hospitalized patients were calculated according to reason for admission, type of hospital, legal nature, and number of admissions per year for each patient. The association between rates of hospitalized patients, number of psychiatric beds per year, and number of Psychosocial Care Centers per year were tested.

RESULTS

We selected a total of 1,549,298 patients, whose most frequent diagnoses on first admission were psychoactive substance use disorders, followed by schizophrenia and mood disorders. The median of hospitalizations per patient was 1.9 and the length of stay per patient was 29 days. The overall rate of hospitalized patients was reduced by almost half in the period. The number of beds per year was positively associated with the rates of hospitalized patients; the number of CAPS per year was negatively associated with some rates of hospitalized patients.

CONCLUSION

Even in the face of adversity, the National Mental Health Policy has advanced in its goal of progressively reducing hospital beds and increasing the supply of substitute services such that both strategies were associated with the reduced inpatient rates. But the changes were felt with greater intensity in the first years of the policy's implementation, becoming less pronounced in recent years.

Factors Associated With Mental Suffering in the Brazilian Population: A Multilevel Analysis

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.

Use and sources of psychotropic drugs by Brazilian adults and seniors

The aim of the present study was to estimate the prevalence of psychotropic drug utilization among adults and seniors and determine associated factors, therapeutic classes and sources of acquisition. Data from the Brazilian National Survey on Access, Use and Promotion of the Rational Use of Medicines (2013-2014) were analyzed. The prevalence of use of at least one psychotropic drug in the overall sample (adults and seniors) was 8.7%. In the adjusted analyses, positive associations were found between the use of psychotropic drugs and the female sex, poorer self-rated health and chronic diseases (p < 0.05). The most frequently used therapeutic classes were antidepressants (55.3%) by the adults and anxiolytics (59.3%) by the seniors. Approximately 23.0% of psychotropic drugs were obtained exclusively from pharmacies of the public healthcare system and 77.0% were acquired from other sources. The findings reveal a low proportion of attaining psychotropic drugs through the Brazilian public healthcare system as well as the need for public policies that encourage the rational use of prescriptions and treatments to promote a better quality of life and ensure the population's right to health.

Depressive disorders in Brazil: results from the Global Burden of Disease Study 2017

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.

The reliability and validity of PHQ-9 in patients with major depressive disorder in psychiatric hospital

BACKGROUND

To assess the reliability and validity of Patient Health Questionnaire-9 (PHQ-9) for patients with major depressive disorder (MDD) and to assess the feasibility of its use in psychiatric hospitals in China.

METHODS

One hundred nine outpatients or inpatients with MDD who qualified the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria completed PHQ-9 and Hamilton Depression Scale (HAMD-17). Two weeks after the initial evaluation, 54 randomly selected patients underwent repeat assessment using PHQ-9. For validity analysis, the construct validity and criterion validity were assessed. The internal concordance coefficient and the test-retest correlation coefficients were used for reliability analysis. The correlation between total score and scores for each item and the correlation between scores for various items were evaluated using Pearson correlation coefficient.

RESULTS

Principal components factor analysis showed good construct validity of the PHQ-9. PHQ-9 total score showed a positive correlation with HAMD-17 total score (r = 0.610, P < 0.001). With HAMD as the standard, PHQ-9 depression scores of 7, 15, and 21 points were used as cut-offs for mild, moderate, and severe depression, respectively. Consistency assessment was conducted between the depression severity as assessed by PHQ-9 and HAMD (Kappa = 0.229, P < 0.001). Intraclass correlation coefficient between PHQ-9 total score and HAMD total score was 0.594 (95% confidence interval, 0.456-0.704, P < 0.001). The Cronbach's α coefficient of PHQ-9 was 0.892. Correlation coefficients between each item score and the total score ranged from 0.567-0.789 (P < 0.01); the correlation coefficient between various item scores ranged from 0.233-0.747. The test-retest correlation coefficient for total score was 0.737.

CONCLUSIONS

PHQ-9 showed good reliability and validity, and high adaptability for patients with MDD in psychiatric hospital. It is a simple, rapid, effective, and reliable tool for screening and evaluation of the severity of depression.

The role of physical activity in the association between multimorbidity and depressive symptoms: Data from 60,202 adults from the Brazilian National Health Survey

OBJECTIVE

Depression is commonly associated to physical multimorbidity and there is an urgent need to identify modifiable risk factors. Physical activity (PA) is good for health, but the association between PA and multimorbidity with depressive symptoms is unclear. Thus, we investigated whether meeting weekly recommended PA guidelines influences the association between multimorbidity and depressive symptoms.

METHODS

Data were used from a national survey conducted in Brazil in 2013 with 60,202 adults (≥ 18 years). Information regarding depressive symptoms (PHQ-9), PA, and chronic disease was collected via interview-administered questionnaires. Data on covariates (age, educational status, employment status, tobacco smoking, alcohol consumption, and TV-viewing) were also assessed. Adjusted logistic regression models were used.

RESULTS

Overall, men and women with one or more chronic conditions who were inactive (engaging in <150 min PA per week) had higher odds of elevated depressive symptoms than active individuals with no chronic condition. However, only in men, physical inactivity interacts with heart disease (OR: 2.59; 95%CI: 1.10 to 6.09), cancer (OR: 21.54; 95%CI: 2.67 to 173.94) and chronic obstructive pulmonary disease (COPD) (OR: 8.26; 95%CI: 2.20 to 31.01) regarding elevated depressive symptoms.

CONCLUSION

Our data suggest that engaging in weekly recommended PA targets may attenuate association of heart disease, cancer and COPD with depressive symptoms among men.

Espacialização da mortalidade por transtornos mentais e comportamentais atribuível ao uso de substâncias psicoativas no Brasil, de 2012 a 2016

Introdução: Os transtornos mentais e de comportamento atribuíveis ao uso de substâncias psicoativas consistem em importante problema de saúde pública, dada a sua prevalência e o risco de promoverem incapacidade e morte. Objetivo: Analisar a distribuição espacial da mortalidade por transtornos mentais e comportamentais atribuível ao uso de substâncias psicoativas no Brasil. Métodos: Estudo ecológico em municípios do Brasil, no período de 2012 a 2016. Analisou-se a distribuição espacial, a intensidade e a significância através do índice de Moran Global, MoranMap e BoxMap. Resultados: A maioria dos óbitos foi atribuível ao uso do álcool (n = 33.177; 77,36%) , seguido do fumo (n = 7.262; 16%) e do uso de múltiplas drogas (n = 1.409; 3,29%), sendo que a maioria (n = 36.861; 85,97%) era do sexo masculino e 46.31% solteiros. Nas faixas de idade entre 40 a 59 anos houve 21.712 óbitos (50,63%), e entre 60 anos e mais, 13.445 óbitos (31,35%). Os municípios que apresentaram as maiores taxas médias de mortalidade padronizadas (óbitos/100 mil hab.) foram: Charrua–RS (43,60), Uru–SP (43,19), Riacho da Cruz–RN (42,21), Senhora do Porto–MG (42,19), Mata–RS (36,81), Pendências–RN (35,26) e Catuji–MG (35,19). O valor do Índice Global de Moran foi de 0,216 (p = 0,01). No MoranMap observou-se formação de cluster de alto/alto nas regiões Nordeste e Sudeste. Conclusão: Existe no Brasil um padrão de dependência espacial na distribuição das taxas de mortalidade atribuíveis ao uso de substâncias psicoativas.

Independent relationships between different domains of physical activity and depressive symptoms among 60,202 Brazilian adults

OBJECTIVE

To analyze the association between four key different physical activity (PA) domains and depressive symptoms among Brazilian adults.

METHODS

Data from the Brazilian National Health Survey (n = 60,202; ≥18 years) were used. PA across four different domains (leisure, transport, occupational and household) was collected through specific questionnaires. The cutoff point adopted in each domain was 150 min/week. Depression was evaluated through the Patient Health Questionnaire-9. Multivariable adjusted linear and logistic regression models were applied.

RESULTS

Leisure PA was associated with lower depressive symptoms [β: -0.008 (95% CI: -0.010 to -0.005); OR: 0.69 (95% CI: 0.59 to 0.81)]. Transport PA was also associated with lower depressive symptoms among older adults [β -0.008 (-0.012 to -0.003); OR: 0.70 (95% CI: 0.53-0.94)] but not middle-aged adults. On the other hand, occupational PA [β: 0.003 (95% CI: 0.002 to 0.005); OR: 1.62 (95% CI: 1.38 to 1.91)] and household PA [β: 0.009 (95% CI: 0.006 to 0.012); OR: 1.57 (95% CI: 1.37 to 1.79)] were associated with higher depressive symptoms.

CONCLUSION

The association between PA and depression symptoms varies according to the domains of PA and some appear independent from each other. While leisure PA is associated with fewer depressive symptoms; occupational and household PA appear to be associated with an increased depression risk.

Associations between primary health care strategies and outcomes of mental disorders

Objective:

To investigate associations between the percentage and severity of mental disorders (MD) and three different primary health care (PHC) strategies in Brazil: traditional care (TC), the Family Health Strategy (FHS), and FHS with shared mental health care (FHS+SC).

Methods:

Random samples were selected from three different areas of a Brazilian city. Each area was served by a different PHC strategy (TC, FHS, or FHS+SC). Five mental health professionals, blinded to the type of PHC strategy delivered in each area, conducted interviews using the Mini International Neuropsychiatric Interview (MINI) and other specific instruments to assess the prevalence and severity of MD.

Results:

530 subjects were interviewed. The TC strategy was significantly associated with a higher percentage of MD when compared to FHS and FHS+SC. These results were not affected by adjustment for sociodemographic variables. The difference in prevalence of MD between the two FHS areas (with and without SC) was not statistically significant. No significant differences in MD severity were observed across the three PHC strategies.

Conclusion:

Areas covered by FHS showed a lower percentage of MD than those covered by TC. Presence of SC did not influence the prevalence of MD, suggesting that mental-health training of FHS teams may have minimized the influence of SC.

Colonização, Guerra e Saúde Mental: Fanon, Martín-Baró e as Implicações para a Psicologia Brasileira

Resumo O presente estudo teórico objetiva discorrer sobre as compreensões de Frantz Fanon e Ignacio Martín-Baró acerca da relação entre guerra, colonização e saúde mental e como podem contribuir ao entendimento de nossa realidade. Ademais, pretendemos refletir como tais subsídios se aplicam à Psicologia brasileira e seu projeto ético-político. Constatamos uma confluência nas análises dos autores, sobretudo a influência de Fanon para Martín-Baró, orientando-se para uma compreensão da saúde mental remetida ao nosso fazimento colonizado e como este se manifesta, é conformado e intensificado por guerras, mesmo que não formais. Finalmente, traçamos implicações para um projeto de Psicologia que aborde a saúde mental na perspectiva dos autores e, assim, transforme-se, contribuindo para o entendimento e mudança de nossa realidade.

The (in)visible health risks of climate change

This paper scrutinizes the assertion that knowledge gaps concerning health risks from climate change are unjust, and must be addressed, because they hinder evidence-led interventions to protect vulnerable populations. First, we construct a taxonomy of six inter-related forms of invisibility (social marginalization, forced invisibility by migrants, spatial marginalization, neglected diseases, mental health, uneven climatic monitoring and forecasting) which underlie systematic biases in current understanding of these risks in Latin America, and advocate an approach to climate-health research that draws on intersectionality theory to address these inter-relations. We propose that these invisibilities should be understood as outcomes of structural imbalances in power and resources rather than as haphazard blindspots in scientific and state knowledge. Our thesis, drawing on theories of governmentality, is that context-dependent tensions condition whether or not benefits of making vulnerable populations legible to the state outweigh costs. To be seen is to be politically counted and eligible for rights, yet evidence demonstrates the perils of visibility to disempowered people. For example, flood-relief efforts in remote Amazonia expose marginalized urban river-dwellers to the traumatic prospect of forced relocation and social and economic upheaval. Finally, drawing on research on citizenship in post-colonial settings, we conceptualize climate change as an 'open moment' of political rupture, and propose strategies of social accountability, empowerment and trans-disciplinary research which encourage the marginalized to reach out for greater power. These achievements could reduce drawbacks of state legibility and facilitate socially-just governmental action on climate change adaptation that promotes health for all.

Ideação suicida e consumo de drogas ilícitas por mulheres

Resumo Objetivo Analisar a relação entre ideação suicida e consumo de drogas ilícitas em mulheres. Métodos Estudo analítico realizado com 369 mulheres atendidas em Unidades Básicas de Saúde utilizando para investigação do consumo de drogas ilícitas o Non-Student Drugs Use Questionnaire e para investigação da ideação suicida o Self-Reporting Questionnaire. Resultados Verificou-se que existe associação entre ideação suicida e o uso de tranquilizantes sem prescrição médica (p=0,005), de solventes (p=0,006) e de maconha (p=0,003). O consumo de tranquilizantes aumenta em 2,7 vezes (IC=1,372-5,608) as chances de as mulheres terem ideação suicida quando comparadas com aquelas que não fazem uso das referidas drogas, bem como pelo uso de solventes em 10,1 vezes (IC=2,197-46,967) e o uso de maconha em 3,3 vezes (IC=1,865-13,900). Conclusão Os indicadores produzidos apontam que uso de drogas ilícitas pelas mulheres tem implicação grave e, portanto, necessita de intervenções efetivas que devem focalizar, sobretudo, na prevenção da ideação suicida, uma vez que a progressão dessa ideação poderá convergir para desfechos trágicos que incluem tentativa de suicídio, automutilação e suicídio.