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Béhague DP, Gonçalves H, da Cruz SH, de Cruz L, Horta BL, Lima NP. The politicizing clinic: insights on 'the social' for mental health policy and practice. Soc Psychiatry Psychiatr Epidemiol 2024; 59:523-536. [PMID: 38108834 PMCID: PMC10944422 DOI: 10.1007/s00127-023-02573-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 09/28/2023] [Indexed: 12/19/2023]
Abstract
PURPOSE In this paper, we explore how Brazilian socially sensitive therapy can respond to care-users' desire to change the social and political forces shaping their lives. We use this case to demonstrate the limits of the "social determinants of health" agenda which, when operationalized, tends to leave questions of lasting structural change aside. METHODS We report on mixed methods ethnographic and epidemiological results from the 1982 Pelotas (Brazil) birth cohort study, a prospective study of 5914 children. Ethnographic analysis explored the cyclical relationship between schooling, mental health care, conceptualizations of mental distress, social and political engagement, and experiences with diverse forms of discrimination. Epidemiological bivariate and multivariate analyses examined differences in socio-political participation and the reporting of discrimination at different time-points for participants who used therapy with those who did not. Effect modification analysis tested the hypothesis that the socially empowering effects of therapy were greater for marginalized and minoritized youth. RESULTS Most young people living in situations of precarity experienced therapy, particularly when based in schools, to be a blame-inducing process. A more fulfilling and impactful therapeutic experience took shape when young people were able to shift the focus away from symptom reduction and behavioral management toward narrative life analyses, social debate, and political agency. Use of socially sensitive therapy was statistically associated with increased political participation and reporting of discrimination after controlling for confounders. The empowering effects of therapy were greater for those with less formal education and family income, but not for young people who identified as black, brown, or non-white. CONCLUSION The findings underscore the importance of considering agency, sociality, and politics when theorizing "the social" in clinical practice, and health and social policy.
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Affiliation(s)
- Dominique P Béhague
- Vanderbilt University, Medicine Health, and Society, Nashville, Tennessee, USA.
- Kings College London, Social Medicine & Global Health, London, UK.
| | - Helen Gonçalves
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | | | - Larissa de Cruz
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Bernardo L Horta
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Natália P Lima
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
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de Sousa AR, Teixeira JRB, Palma EMS, Moreira WC, Santos MB, de Carvalho HEF, Almeida ÉS, Florencio RMS, de Queiroz AM, Merces MCD, Mota TN, Araújo IFM, da Silva JC, dos Santos SD, Camargo ELS, Lourenção LG, da Silva RAR, Carvalho ESDS, Lua I, Barros S, de Araújo TM, de Oliveira MAF, Pereira Á, Abreu W, da Cruz Sequeira CA. Psychological Distress in Men during the COVID-19 Pandemic in Brazil: The Role of the Sociodemographic Variables, Uncertainty, and Social Support. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:ijerph19010350. [PMID: 35010610 PMCID: PMC8744977 DOI: 10.3390/ijerph19010350] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/16/2021] [Accepted: 12/18/2021] [Indexed: 12/28/2022]
Abstract
Objective: To analyze the relationships between sociodemographic variables, intolerance to uncertainty (INT), social support, and psychological distress (i.e., indicators of Common Mental Disorders (CMDs) and perceived stress (PS)) in Brazilian men during the COVID-19 pandemic. Methods: A cross-sectional study with national coverage, of the web survey type, and conducted with 1006 Brazilian men during the period of social circulation restriction imposed by the health authorities in Brazil for suppression of the coronavirus and control of the pandemic. Structural equation modeling analysis was performed. Results: Statistically significant direct effects of race/skin color (λ = 0.268; p-value < 0.001), socioeconomic status (SES) (λ = 0.306; p-value < 0.001), household composition (λ = 0.281; p-value < 0.001), PS (λ = 0.513; p-value < 0.001), and INT (λ = 0.421; p-value < 0.001) were evidenced in the occurrence of CMDs. Black-skinned men with higher SES, living alone, and with higher PS and INT levels presented higher prevalence values of CMDs. Conclusions: High levels of PS and INT were the factors that presented the strongest associations with the occurrence of CMDs among the men. It is necessary to implement actions to reduce the stress-generating sources as well as to promote an increase in resilience and the development of intrinsic reinforcements to deal with uncertain threats.
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Affiliation(s)
- Anderson Reis de Sousa
- Escola de Enfermagem, Universidade Federal da Bahia, Salvador 40231-300, BA, Brazil; (A.R.d.S.); (M.B.S.); (É.S.A.); (I.F.M.A.); (J.C.d.S.); (Á.P.)
| | - Jules Ramon Brito Teixeira
- Departamento de Saúde, Universidade Estadual de Feira de Santana, Feira de Santana 44001-970, BA, Brazil; (J.R.B.T.); (S.D.d.S.); (E.S.d.S.C.); (T.M.d.A.)
| | | | - Wanderson Carneiro Moreira
- Escola de Enfermagem, Universidade de São Paulo, Sao Paulo 05403-000, SP, Brazil; (W.C.M.); (S.B.); (M.A.F.d.O.)
- Coordenação de Saúde do Adolescente, Jovem e Homem, Diretoria Técnica, Secretaria de Saúde, Prefeitura Municipal de Ananindeua, Ananindeua 67130-600, PA, Brazil
| | - Milena Bitencourt Santos
- Escola de Enfermagem, Universidade Federal da Bahia, Salvador 40231-300, BA, Brazil; (A.R.d.S.); (M.B.S.); (É.S.A.); (I.F.M.A.); (J.C.d.S.); (Á.P.)
| | | | - Éric Santos Almeida
- Escola de Enfermagem, Universidade Federal da Bahia, Salvador 40231-300, BA, Brazil; (A.R.d.S.); (M.B.S.); (É.S.A.); (I.F.M.A.); (J.C.d.S.); (Á.P.)
| | | | | | | | - Tilson Nunes Mota
- Secretaria de Ciência, Tecnologia e Inovação, Salvador 41745-004, BA, Brazil;
| | - Isabella Félix Meira Araújo
- Escola de Enfermagem, Universidade Federal da Bahia, Salvador 40231-300, BA, Brazil; (A.R.d.S.); (M.B.S.); (É.S.A.); (I.F.M.A.); (J.C.d.S.); (Á.P.)
| | - Josielson Costa da Silva
- Escola de Enfermagem, Universidade Federal da Bahia, Salvador 40231-300, BA, Brazil; (A.R.d.S.); (M.B.S.); (É.S.A.); (I.F.M.A.); (J.C.d.S.); (Á.P.)
| | - Sélton Diniz dos Santos
- Departamento de Saúde, Universidade Estadual de Feira de Santana, Feira de Santana 44001-970, BA, Brazil; (J.R.B.T.); (S.D.d.S.); (E.S.d.S.C.); (T.M.d.A.)
| | | | | | | | - Evanilda Souza de Santana Carvalho
- Departamento de Saúde, Universidade Estadual de Feira de Santana, Feira de Santana 44001-970, BA, Brazil; (J.R.B.T.); (S.D.d.S.); (E.S.d.S.C.); (T.M.d.A.)
| | - Iracema Lua
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador 40110-040, BA, Brazil;
| | - Sônia Barros
- Escola de Enfermagem, Universidade de São Paulo, Sao Paulo 05403-000, SP, Brazil; (W.C.M.); (S.B.); (M.A.F.d.O.)
| | - Tânia Maria de Araújo
- Departamento de Saúde, Universidade Estadual de Feira de Santana, Feira de Santana 44001-970, BA, Brazil; (J.R.B.T.); (S.D.d.S.); (E.S.d.S.C.); (T.M.d.A.)
| | - Márcia Aparecida Ferreira de Oliveira
- Escola de Enfermagem, Universidade de São Paulo, Sao Paulo 05403-000, SP, Brazil; (W.C.M.); (S.B.); (M.A.F.d.O.)
- Programa de Pós-Graduação em Enfermagem, Centro de Ciências da Saúde, Universidade Federal de Santa Maria, Santa Maria 97105-900, RS, Brazil
| | - Álvaro Pereira
- Escola de Enfermagem, Universidade Federal da Bahia, Salvador 40231-300, BA, Brazil; (A.R.d.S.); (M.B.S.); (É.S.A.); (I.F.M.A.); (J.C.d.S.); (Á.P.)
| | - Wilson Abreu
- Centro de Investigação em Tecnologias e Serviços de Saúde, Escola Superior de Enfermagem do Porto, 4200-072 Porto, Portugal;
| | - Carlos Alberto da Cruz Sequeira
- Centro de Investigação em Tecnologias e Serviços de Saúde, Escola Superior de Enfermagem do Porto, 4200-072 Porto, Portugal;
- Correspondence:
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Riter HDS, Almeida ML, Vescovi G, Marques FM, Pedrotti BG, Mallmann MY, Pieta MAM, Frizzo GB. Symptoms of Common Mental Disorders in Brazilian Parents During the COVID-19 Pandemic: Associated Factors. PSYCHOLOGICAL STUDIES 2021; 66:270-279. [PMID: 34334820 PMCID: PMC8315494 DOI: 10.1007/s12646-021-00609-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 06/01/2021] [Indexed: 01/05/2023] Open
Abstract
COVID-19 pandemic has become a significant international public health problem. In addition to dealing with the pandemic's impact on mental health, parents need to cope with specific changes in their routines caused by social distance measures. This study aimed to investigate common mental disorders (CMD) symptoms in Brazilian parents during the COVID-19 pandemic and its associated factors. A total of 232 Brazilian parents ranging from 20 to 48 years old (M = 33.85; SD = 4.83) with children aged 1-36 months (M = 17.00; SD = 9,87) participated in an online survey. Parents answered a sociodemographic questionnaire, Self-Report Questionnaire (SRQ-20), Perceived Stress Scale (PSS-4), and Parenting Sense of Competence Scale. Chi-square tests, correlations, and multiple linear regression were performed. Results showed that parents' symptoms of CMD were negatively associated to perceived parental competence (β =- 0.130; p = 0.011) and family income (β =- 0.190; p = 0.024). Furthermore, perceived stress was the most related variable to parents' symptoms of CMD (β = 0.618; p < 0.001), showing a positive association. The model explained 49.5% of the variation. Results suggest that lower family income may increase symptoms of CMD in Brazilian parents, which is a concern in a country of high social inequality. Parental sense of competence may be a relevant protective factor. Interventions targeting parental competence and stress reduction should be considered to address the mental health impacts of the pandemic.
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Affiliation(s)
- Helena da Silveira Riter
- Psychology Institute, Universidade Federal Do Rio Grande Do Sul, Ramiro Barcelos Street, 2600/112, Porto Alegre, Rio Grande Do Sul (RS) CEP – 90035003 Brazil
| | - Maíra Lopes Almeida
- Psychology Institute, Universidade Federal Do Rio Grande Do Sul, Ramiro Barcelos Street, 2600/112, Porto Alegre, Rio Grande Do Sul (RS) CEP – 90035003 Brazil
| | - Gabriela Vescovi
- Psychology Institute, Universidade Federal Do Rio Grande Do Sul, Ramiro Barcelos Street, 2600/112, Porto Alegre, Rio Grande Do Sul (RS) CEP – 90035003 Brazil
| | - Fernanda Martins Marques
- Psychology Institute, Universidade Federal Do Rio Grande Do Sul, Ramiro Barcelos Street, 2600/112, Porto Alegre, Rio Grande Do Sul (RS) CEP – 90035003 Brazil
| | - Bruna Gabriella Pedrotti
- Psychology Institute, Universidade Federal Do Rio Grande Do Sul, Ramiro Barcelos Street, 2600/112, Porto Alegre, Rio Grande Do Sul (RS) CEP – 90035003 Brazil
| | - Manoela Yustas Mallmann
- Psychology Institute, Universidade Federal Do Rio Grande Do Sul, Ramiro Barcelos Street, 2600/112, Porto Alegre, Rio Grande Do Sul (RS) CEP – 90035003 Brazil
| | - Maria Adélia Minghelli Pieta
- Psychology Institute, Universidade Federal Do Rio Grande Do Sul, Ramiro Barcelos Street, 2600/112, Porto Alegre, Rio Grande Do Sul (RS) CEP – 90035003 Brazil
| | - Giana Bitencourt Frizzo
- Psychology Institute, Universidade Federal Do Rio Grande Do Sul, Ramiro Barcelos Street, 2600/112, Porto Alegre, Rio Grande Do Sul (RS) CEP – 90035003 Brazil
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Trude ACB, Richter LM, Behrman JR, Stein AD, Menezes AMB, Black MM. Effects of responsive caregiving and learning opportunities during pre-school ages on the association of early adversities and adolescent human capital: an analysis of birth cohorts in two middle-income countries. THE LANCET. CHILD & ADOLESCENT HEALTH 2021; 5:37-46. [PMID: 33340466 PMCID: PMC7763480 DOI: 10.1016/s2352-4642(20)30309-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 09/02/2020] [Accepted: 09/07/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND Millions of children globally are at risk of not reaching their developmental potential because of early adversities. We hypothesised that responsive caregiving and learning opportunities, components of nurturing care, at pre-school ages might mitigate the effects of adversities. METHODS We analysed longitudinal birth cohort data from Brazil (1993 Pelotas Birth Cohort, n=632) and South Africa (Birth to Twenty Plus [Bt20+] Birth Cohort, n=1130) to assess whether responsive caregiving and learning opportunities at pre-school ages (2-4 years) modified associations between cumulative early adversities and adolescent human capital. The cumulative adversities score (range 0-9) included household wealth and crowding; mothers' schooling, height, age, and mental health; and children's birthweight, gestational age, and length at age 12 months. We extracted data on responsive caregiving and learning opportunities from the Early Childhood Home Observation for Measurement of the Environment inventory, assessed at age 4 years (1993 Pelotas cohort) and 2 years (Bt20+ cohort). We examined three human capital indicators: intelligence quotient (IQ) assessed at age 18 years (1993 Pelotas cohort) and 16 years (Bt20+ cohort); psychosocial adjustment assessed at age 15 years and 14 years, respectively; and height assessed at age 18 years and 16 years, respectively. We used linear models with interaction terms between cumulative adversities, and responsive caregiving and learning opportunities, to predict adolescent human capital. FINDINGS For each additional Z score of total cumulative adversity, adolescent IQ decreased by 5·89 (95% CI -7·29 to -4·50) points in the 1993 Pelotas cohort (p<0·0001) and 2·69 (-4·52 to -0·86) points in the Bt20+ cohort (p=0·0039). After adjusting for total cumulative adversities, adolescent IQ points increased by 5·47 (95% CI 4·20 to 6·74) with each additional Z score of learning opportunities and by 2·26 (0·93 to 3·59) with each additional Z score of responsive caregiving in the 1993 Pelotas cohort, but not in the Bt20+ cohort (0·86 [-0·12 to 1·83] and 0·65 [-0·32 to 1·61], respectively). Associations between early adversities and IQ were modified by learning opportunities in the 1993 Pelotas cohort (beta coefficient for interaction 1·74, 95% CI 0·43 to 3·04; p=0·0092) and by responsive caregiving in the Bt20+ cohort (2·24, 0·94 to 3·54; p=0·0075). High nurturing environment attenuated the negative effects of early cumulative adversities on IQ. INTERPRETATION Early nurturing home environments protect young children against effects of early adversities on adolescent IQ, with long-term positive associations on adolescent cognition in two middle-income countries. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Angela C B Trude
- Growth and Nutrition Division, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Linda M Richter
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Jere R Behrman
- Economics Department, The Ronald O Perelman Center for Political Science and Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Aryeh D Stein
- Hubert Department of Global Health, Rollins School of Public Health Emory University, Atlanta, GA, USA
| | - Ana M B Menezes
- Postgraduate Program of Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Maureen M Black
- Growth and Nutrition Division, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA; RTI International, Durham, NC, USA.
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Yoshikawa H, Wuermli AJ, Britto PR, Dreyer B, Leckman JF, Lye SJ, Ponguta LA, Richter LM, Stein A. Effects of the Global Coronavirus Disease-2019 Pandemic on Early Childhood Development: Short- and Long-Term Risks and Mitigating Program and Policy Actions. J Pediatr 2020; 223:188-193. [PMID: 32439312 PMCID: PMC7234941 DOI: 10.1016/j.jpeds.2020.05.020] [Citation(s) in RCA: 120] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 05/13/2020] [Accepted: 05/13/2020] [Indexed: 12/17/2022]
Affiliation(s)
| | | | | | - Benard Dreyer
- Division of Developmental-Behavioral Pediatrics, New York University School of Medicine, New York, NY; Department of Pediatrics, Bellevue Hospital Center, New York, NY
| | - James F Leckman
- Departments of Child Psychiatry, Pediatrics and Psychology, Yale University, New Haven, CT
| | - Stephen J Lye
- Alliance for Human Development, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada; Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada
| | | | - Linda M Richter
- DST-NRF Centre of Excellence in Human Development , University of the Witwatersrand, Johannesburg, South Africa
| | - Alan Stein
- Department of Child and Adolescent Psychiatry, University of Oxford, Oxford, UK
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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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Santos GDBVD, Alves MCGP, Goldbaum M, Cesar CLG, Gianini RJ. [Prevalence of common mental disorders and associated factors in urban residents of São Paulo, Brazil]. CAD SAUDE PUBLICA 2019; 35:e00236318. [PMID: 31691788 DOI: 10.1590/0102-311x00236318] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 05/24/2019] [Indexed: 11/22/2022] Open
Abstract
Studies in developing countries report a steady increase in mental disorders, with major social and economic repercussions. The current study proposes to analyze the prevalence of common mental disorders (CMDs) and associated factors in urban residents of São Paulo, Brazil. Based on data collected in the Health Survey in São Paulo City (ISA-Capital) in 2015, the study identified the presence of CMDs using the Self-Reporting Questionnaire (SRQ-20). The association of CMDs with sociodemographic variables and health conditions was analyzed as relative frequency, corrected by the respective weights resulting from cluster sampling, estimating the prevalence and 95% confidence intervals (95%CI) and assessing the association's significance by the chi-square test, corrected by the F distribution. Prevalence of CMDs was 19.7% (95%CI: 18.2-21.4), higher in women (24.3%); persons 60 years or older (25.3%); followers of the African-Brazilian umbanda or candomblé religions (37.8%); widows/widowers (30.4%); individuals that had never attended school (31.4%); unemployed (28.3%); those with family income up to one minimum wage (28.8%); individuals that reported illness in the previous 15 days (36.9%); those with physical disabilities (21.6%); mental or intellectual disabilities (44.4%); emotional or mental problems (48.9%); headache (33.63%); and individuals with one or more chronic diseases (24.1%). The information in this study reaffirms the relevance of the prevalence of CMDs and their association with the most vulnerable social groups, corroborating the need to implement public measures in mental health.
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Affiliation(s)
| | | | - Moises Goldbaum
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brasil
| | | | - Reinaldo José Gianini
- Faculdade de Ciências Médicas e da Saúde, Pontifícia Universidade Católica de São Paulo, Sorocaba, Brasil
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Sousa SQD, Lôbo IKV, Carvalho ATD, Vianna RPDT. Associação entre risco de transtornos mentais comuns e insegurança alimentar entre mães com filhos menores de um ano de idade. CIENCIA & SAUDE COLETIVA 2019; 24:1925-1934. [DOI: 10.1590/1413-81232018245.17012017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 08/30/2017] [Indexed: 11/22/2022] Open
Abstract
Resumo Insegurança alimentar e nutricional está relacionada a problemas nutricionais e de saúde, entretanto poucos estudos a relacionam com saúde mental. O objetivo deste artigo é Investigar associação da insegurança alimentar familiar e risco de transtornos mentais comuns (TMC) em mães com filhos de um ano de idade. Estudo de coorte prospectivo com 194 mães e seus filhos desde o nascimento. Insegurança alimentar foi medida aos quatro meses pós-parto, com a Escala Brasileira de Insegurança Alimentar e risco de diagnóstico positivo de TMC nas mães ao final do primeiro ano da criança, com o Self Response Questionnaire (SRQ-20). Medidas socioeconômicas e de saúde foram utilizadas como controle. Das famílias, 59,3% apresentavam insegurança alimentar, tendo razão de risco para diagnóstico de TMC de 1,59 (IC 95%: 1,10 – 2,31), comparado com famílias em segurança alimentar. Após ajuste, modelo logístico múltiplo estimou OR = 2,20 (IC 95%: 1,16 – 4,20) para esta relação. Observou-se associação da insegurança alimentar familiar aos quatro meses pós-parto e risco de diagnóstico de TMC entre mães ao final do primeiro ano dos filhos. O enfrentamento da insegurança alimentar deve fazer parte das estratégias promotoras da saúde materna e da qualidade de vida materno-infantil.
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Secretti T, Nunes MAA, Schmidt MI, Stein MC, Santos SM. Characteristics of neighborhood environment (social cohesion and safety) and common mental disorders in ELSA-Brasil study: a multilevel analysis. CAD SAUDE PUBLICA 2019; 35:e00197017. [DOI: 10.1590/0102-311x00197017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 08/17/2018] [Indexed: 11/22/2022] Open
Abstract
The purpose of this study was to determine if self-reported characteristics of social cohesion and local neighborhood safety positively affect the mental health of their residents, regardless of individual characteristics. A sample of participants in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline was used. The Clinical Interview Schedule-Revised (CIS-R) instrument was used for tracking common mental disorders (CMD). Social cohesion and safety were measured by validated scales of neighborhood environment self-reported characteristics. The multilevel logistic regression model was used to estimate the effect in neighborhoods (level 2) and individuals (level 1), as well as the odds ratios for each neighborhood explanatory variable and social characteristics in the CMD. The results showed that part of the variance (2.3%), in the common mental disorders prevalence is attributed to local neighborhoods. The characteristics of social cohesion and safety remained significant, even after the adjustment of individual explanatory variables. This study confirmed the hypothesis that individuals living in neighborhoods where they perceive low social cohesion and safety present a higher chance of developing CMD.
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Prevalence and correlates of common mental disorders among dental students in Brazil. PLoS One 2018; 13:e0204558. [PMID: 30261025 PMCID: PMC6160106 DOI: 10.1371/journal.pone.0204558] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 09/11/2018] [Indexed: 11/19/2022] Open
Abstract
This study aimed to estimate prevalence of common mental disorders (CMD) and associated factors among dental students. In this cross-sectional study, 230 students answered a questionnaire and instruments to assess CMD (Self Reporting Questionnaire-20), hazardous alcohol consumption (Alcohol Use Disorder Identification Test), social support (Social Support Scale), perceptions of academic life (Dundee Ready Education Environment Measure), coping (Ways of Coping Inventory) and resilience (Resilience Scale). Bivariate analysis was conducted using the Chi-Square and Mann-Whitney tests. Logistic regression included all explanatory variableswith p<0.20 in the bivariate analysis, besides sex and academic year. The explanatory variables were analyzed in five successive blocks (backward-stepwise), until all variables presented statistical significance in the final model (p<0.05). The prevalence of CMD was 45.2% (95%CI: 38.7–51.6), with no significant differences between sexes. Students with no extracurricular activities, who had negatively self- assessed their health status and their academic performance, were about four times more likely to present CMD, followed by receiving psychological or psychiatric treatment during university (AOR: 2.65; 95%CI: 1.1–6.1) and those with high scores for confrontive coping (AOR: 1.20; 95%CI: 1.0–1.4). Resilience was a protective factor for CMD among dental students (AOR: 0.93; 95%CI: 0.9–1.0). Aspects related to academic performance, health status and confrontive coping strategies were risk factors to students’ mental health. Individuals with high levels of resilience showed lower prevalence of CMD. Further prospective studies could contribute to understanding the role of resilience among this population.
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Smolen JR, de Araújo EM, de Oliveira NF, de Araújo TM. Intersectionality of Race, Gender, and Common Mental Disorders in Northeastern Brazil. Ethn Dis 2018; 28:207-214. [PMID: 30038483 DOI: 10.18865/ed.28.3.207] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
This study applies the perspective of intersectionality, defined as social identities combining with one another and with structural societal factors to produce health inequities, to assess the interaction between race, gender, and common mental disorders (CMD) in northeastern Brazil. The Self-Reporting Questionnaire was used to assess CMD among a representative sample of adults in Feira de Santana, Bahia, Brazil (N=3273). Four groups (Black men, Black women, White women, White men) represented the intersection of race and gender. We used a Chi square test to compare the four groups and Poisson regressions to determine prevalence ratios (PR). White men had the lowest prevalence of CMD (11.1%) and Black women had the highest (37.2%). After adjusting for covariates, Black women had a statistically significantly higher prevalence of CMD than White men (PR=2.43; 95% CI: 1.39-4.25), though the prevalence among White women was not statistically significantly different from White men (PR=1.74; 95% CI: .93-3.30). Interaction tests were conducted on the multiplicative and additive scale, although the results were not statistically significant. These findings indicate that the experience of being both Black and a woman in Brazil is associated with elevated prevalence of CMD. Programs and interventions are needed to address this burden and research is needed to further explore its cause.
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12
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Santos IS, Barros FC, Munhoz T, Matijasevich A. Gestational age at birth and behavioral problems from four to 11 years of age: birth cohort study. BMC Pediatr 2017; 17:184. [PMID: 28835237 PMCID: PMC5569485 DOI: 10.1186/s12887-017-0936-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 08/17/2017] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Studies conducted mainly in high-income countries have shown that preterm births are associated with increased risk of behavioral problems and psychiatric disorders. The aim of this study was to assess the prevalence of behavioral problems from middle-childhood to early-adolescence according to gestational age at birth in a middle-income setting. METHODS A population-based birth cohort (n = 4231) in Pelotas, Brazil, was followed-up in several occasions from birth to 11 years. Estimated GA was based on last menstrual period or, when unknown or inconsistent, on the Dubowitz method. Behavioral problems were assessed at 4 (Child Behavior Checklist - CBCL), and at 6 and 11 years (Development and Well-Being Assessment - DAWBA) tool. Maternal socio-economic characteristics and depression at 2, 4 and 6 years post-partum, child perinatal characteristics and breastfeeding duration were used as confounders. Analyses were run by linear and logistic regression. RESULTS Three thousand two hundred four children had full information on gestational age, CBCL and DAWBA. At 4 years, mean total (42.9 ± 24.0) and mean externalizing (18.8 ± 9.1) CBCL scores were higher among preterm girls born at <34 weeks than among full term girls (33.2 ± 15.1 and 15.0 ± 6.6, respectively). After controlling for confounders the association was no longer significant. At the age of 6 years there was no association between gestational age and behavior, neither in crude nor in adjusted analyses. Odds ratio for any psychiatric disorders at 11 years was 60% (1.6; 1.1-2.1) higher among those born at 34-36 weeks than in full-term children, but the association disappeared in adjusted analyses. CONCLUSION At this large cohort, behavioral problems from middle-childhood to early-adolescence are more related to family socio-economic characteristics and to other child perinatal conditions than to gestational age at birth.
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Affiliation(s)
- Iná S Santos
- Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro 1160, 3o piso, Pelotas, RS, 96020220, Brazil.
| | - Fernando C Barros
- Program in Epidemiology, Federal University of Pelotas and Postgraduate Program in Health and Behaviour, Catholic University of Pelotas, Pelotas, RS, Brazil
| | - Tiago Munhoz
- Faculty of Psychology, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Alicia Matijasevich
- Department of Preventive Medicine, University of São Paulo, São Paulo, SP, Brazil
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Bitew T, Hanlon C, Kebede E, Honikman S, Fekadu A. Antenatal depressive symptoms and perinatal complications: a prospective study in rural Ethiopia. BMC Psychiatry 2017; 17:301. [PMID: 28830395 PMCID: PMC5568236 DOI: 10.1186/s12888-017-1462-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 08/11/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Antenatal depressive symptoms affect around 12.3% of women in in low and middle income countries (LMICs) and data are accumulating about associations with adverse outcomes for mother and child. Studies from rural, low-income country community samples are limited. This paper aims to investigate whether antenatal depressive symptoms predict perinatal complications in a rural Ethiopia setting. METHODS A population-based prospective study was conducted in Sodo district, southern Ethiopia. A total of 1240 women recruited in the second and third trimesters of pregnancy were followed up until 4 to 12 weeks postpartum. Antenatal depressive symptoms were assessed using a locally validated version of the Patient Health Questionnaire (PHQ-9) that at a cut-off score of five or more indicates probable depression. Self-report of perinatal complications, categorised as maternal and neonatal were collected by using structured interviewer administered questionnaires at a median of eight weeks post-partum. Multivariate analysis was conducted to examine the association between antenatal depressive symptoms and self-reported perinatal complications. RESULT A total of 28.7% of women had antenatal depressive symptoms (PHQ-9 score ≥ 5). Women with antenatal depressive symptoms had more than twice the odds of self-reported complications in pregnancy (OR=2.44, 95% CI: 1.84, 3.23), labour (OR= 1.84 95% CI: 1.34, 2.53) and the postpartum period (OR=1.70, 95% CI: 1.23, 2.35) compared to women without these symptoms. There was no association between antenatal depressive symptoms and pregnancy loss or neonatal death. CONCLUSION Antenatal depressive symptoms are associated prospectively with self-reports of perinatal complications. Further research is necessary to further confirm these findings in a rural and poor context using objective measures of complications and investigating whether early detection and treatment of depressive symptoms reduces these complications.
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Affiliation(s)
- Tesera Bitew
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia. .,Department of Psychology, Institute of Education and Behavioral Sciences, Debre Markos University, Debre Markos, Ethiopia.
| | - Charlotte Hanlon
- 0000 0001 1250 5688grid.7123.7Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia ,0000 0001 2322 6764grid.13097.3cHealth Services and Population Research Department, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, Centre for Global Mental Health, London, UK
| | - Eskinder Kebede
- 0000 0001 1250 5688grid.7123.7Department of Obstetrics and Gynecology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Simone Honikman
- 0000 0004 1937 1151grid.7836.aDepartment of Psychiatry and Mental Health, Perinatal Mental Health Project, Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa
| | - Abebaw Fekadu
- 0000 0001 1250 5688grid.7123.7Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia ,0000 0001 2322 6764grid.13097.3cDepartment of Psychological Medicine, Centre for Affective Disorders, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK ,0000 0001 1250 5688grid.7123.7Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia
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14
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Bitew T, Hanlon C, Kebede E, Honikman S, Onah MN, Fekadu A. Antenatal depressive symptoms and utilisation of delivery and postnatal care: a prospective study in rural Ethiopia. BMC Pregnancy Childbirth 2017; 17:206. [PMID: 28662641 PMCID: PMC5492297 DOI: 10.1186/s12884-017-1383-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 06/13/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Uptake of delivery and postnatal care remains low in Low and Middle-Income Countries (LMICs), where 99% of global maternal deaths take place. However, the potential impact of antenatal depression on use of institutional delivery and postnatal care has seldom been examined. This study aimed to examine whether antenatal depressive symptoms are associated with use of maternal health care services. METHODS A population-based prospective study was conducted in Sodo District, Southern Ethiopia. Depressive symptoms were assessed during pregnancy with a locally validated, Amharic version of the Patient Health Questionnaire (PHQ-9). A cut off score of five or more indicated possible depression. A total of 1251 women were interviewed at a median of 8 weeks (4-12 weeks) after delivery. Postnatal outcome variables were: institutional delivery care utilization, type of delivery, i.e. spontaneous or assisted, and postnatal care utilization. Multivariate logistic regression was used to examine the association between antenatal depressive symptoms and the outcome variables. RESULTS High levels of antenatal depressive symptoms (PHQ score 5 or higher) were found in 28.7% of participating women. Nearly two-thirds, 783 women (62.6%), delivered in healthcare institutions. After adjusting for potential confounders, women with antenatal depressive symptoms had increased odds of reporting institutional birth [adjusted Odds Ratio (aOR) =1.42, 95% Confidence Interval (CI): 1.06, 1.92] and increased odds of reporting having had an assisted delivery (aOR = 1.72, 95% CI: 1.10, 2.69) as compared to women without these symptoms. However, the increased odds of institutional delivery among women with antenatal depressive symptoms was associated with unplanned delivery care use mainly due to emergency reasons (aOR = 1.62, 95% CI: 1.09, 2.42) rather than planning to deliver in healthcare institutions. CONCLUSION Improved detection and treatment of antenatal depression has the potential to increase planned institutional delivery and reduce perinatal complications, thus contributing to a reduction in maternal morbidity and mortality.
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Affiliation(s)
- Tesera Bitew
- Addis Ababa University, College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa, Ethiopia. .,Debre Markos University, Institute of Educational and Behavioural Sciences, Department of Psychology, Debre Markos, Ethiopia.
| | - Charlotte Hanlon
- Addis Ababa University, College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa, Ethiopia.,King's College London, Institute of Psychiatry, Psychology and Neuroscience, Centre for Global Mental Health, London, UK
| | - Eskinder Kebede
- Addis Ababa University, College of Health Sciences, Department of Obstetrics and Gynecology, Addis Ababa, Ethiopia
| | - Simone Honikman
- University of Cape Town, Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, Perinatal Mental Health Project, Cape Town, South Africa
| | - Michael N Onah
- University of Cape Town, Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, Perinatal Mental Health Project, Cape Town, South Africa
| | - Abebaw Fekadu
- Addis Ababa University, College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa, Ethiopia.,King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Centre for Affective Disorders, London, UK.,Addis Ababa University, Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa, Ethiopia
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15
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Haile YG, Alemu SM, Habtewold TD. Common mental disorder and its association with academic performance among Debre Berhan University students, Ethiopia. Int J Ment Health Syst 2017; 11:34. [PMID: 28473869 PMCID: PMC5415756 DOI: 10.1186/s13033-017-0142-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 04/21/2017] [Indexed: 11/28/2022] Open
Abstract
Background Common mental disorder (CMD) is prevalent in industrialized and non-industrialized countries. The prevalence of CMD among university students was 28.8–44.7% and attributed to several risk factors, such as schooling. The aim of this study was to assess the prevalence and risk factors of CMD. In addition, the association between CMD and academic performance was tested. Methods Institution based cross-sectional study was conducted with 422 students at Debre Berhan university from March to April 2015. CMD was the primary outcome variable whereas academic performance was the secondary outcome variable. Kessler psychological distress (K10) scale was used to assess CMD. Bivariate and multiple logistic regression analysis were performed for modeling the primary outcome variable; independent samples T test and linear regression analysis were carried out for modeling the secondary outcome variable. The strength of association was interpreted using odds ratio and regression coefficient (β) and decision on statistical significance was made at a p value of 0.05. Data were entered using EPI-data version 3.1 software and analyzed using the Statistical Package for the Social Sciences (SPSS) version 20.01 software. Results The prevalence of CMD was 63.1%. Field of study (p = 0.008, OR = 0.2, 95% CI 0.04–0.61), worshiping (p = 0.04, OR = 1.8, 95% CI 1.02–3.35), insomnia (p < 0.001, OR = 3.8, 95% CI 2.21–6.57), alcohol drinking (p = 0.006, OR = 2.7, 95% CI 1.33–5.66), and headache (p = 0.02, OR = 2.1, 95% CI 1.10–3.86) were identified risk factors for CMD. The mean cumulative grade point average of students with CMD was lower by 0.02 compared to those without CMD, but not statistically significant (p = 0.70, β = −0.02, 95% CI −0.15 to 0.10). CMD explained only 0.8% (r2 = 0.008) of the difference in academic performance between students. Conclusions At least three out of five students fulfilled CMD diagnostic criteria. The statistically significant risk factors were field of study, worshiping, insomnia, alcohol drinking, and headache. Moreover, there was no statistically significant association between CMD and academic performance. Undertaking integrated evidence-based intervention focusing on students with poor sleep quality, poor physical health, and who drink alcohol is essential if the present finding confirmed by a longitudinal study.
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Affiliation(s)
| | - Sisay Mulugeta Alemu
- Mental Health and Psychosocial Support Program, International Medical Corps, Dolo Ado, Ethiopia
| | - Tesfa Dejenie Habtewold
- Department of Epidemiology and Rob Giel Research Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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16
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Nunes MA, Pinheiro AP, Bessel M, Brunoni AR, Kemp AH, Benseñor IM, Chor D, Barreto S, Schmidt MI. Common mental disorders and sociodemographic characteristics: baseline findings of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). BRAZILIAN JOURNAL OF PSYCHIATRY 2016; 38:91-7. [PMID: 27304755 PMCID: PMC7111374 DOI: 10.1590/1516-4446-2015-1714] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 01/08/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To assess the prevalence of common mental disorders (CMD) and the association of CMD with sociodemographic characteristics in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort. METHODS We analyzed data from the cross-sectional baseline assessment of the ELSA-Brasil, a cohort study of 15,105 civil servants from six Brazilian cities. The Clinical Interview Schedule-Revised (CIS-R) was used to investigate the presence of CMD, with a score ≥ 12 indicating a current CMD (last week). Specific diagnostic algorithms for each disorder were based on the ICD-10 diagnostic criteria. Prevalence ratios (PR) of the association between CMD and sociodemographic characteristics were estimated by Poisson regression. RESULTS CMD (CIS-R score ≥ 12) was found in 26.8% (95% confidence intervals [95%CI] 26.1-27.5). The highest burden occurred among women (PR 1.9; 95%CI 1.8-2.0), the youngest (PR 1.7; 95%CI 1.5-1.9), non-white individuals, and those without a university degree. The most frequent diagnostic category was anxiety disorders (16.2%), followed by depressive episodes (4.2%). CONCLUSION The burden of CMD was high, particularly among the more socially vulnerable groups. These findings highlight the need to strengthen public policies aimed to address health inequities related to mental disorders.
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Affiliation(s)
- Maria A Nunes
- Universidade Federal do Rio Grande do Sul, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS , Brazil, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Andréa P Pinheiro
- Universidade Federal do Rio Grande do Sul, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS , Brazil, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Marina Bessel
- Universidade Federal do Rio Grande do Sul, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS , Brazil, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - André R Brunoni
- Hospital Universitário, Universidade de São Paulo, Universidade de São Paulo, São Paulo, SP , Brazil, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Andrew H Kemp
- Hospital Universitário, Universidade de São Paulo, Universidade de São Paulo, São Paulo, SP , Brazil, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brazil.,School of Psychology, Faculty of Science, University of Sydney, University of Sydney, Sydney, New South Wales , Australia, School of Psychology, Faculty of Science, University of Sydney, Sydney, New South Wales, Australia.,Discipline of Psychiatry, Northern Clinical School, Faculty of Medicine, University of Sydney, University of Sydney, Sydney, New South Wales , Australia, Discipline of Psychiatry, Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Isabela M Benseñor
- Hospital Universitário, Universidade de São Paulo, Universidade de São Paulo, São Paulo, SP , Brazil, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Dora Chor
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro. RJ , Brazil, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Sandhi Barreto
- Universidade Federal de Minas Gerais, Universidade Federal de Minas Gerais, Belo Horizonte, MG , Brazil, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Maria I Schmidt
- Universidade Federal do Rio Grande do Sul, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS , Brazil, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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17
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Bitew T, Hanlon C, Kebede E, Medhin G, Fekadu A. Antenatal depressive symptoms and maternal health care utilisation: a population-based study of pregnant women in Ethiopia. BMC Pregnancy Childbirth 2016; 16:301. [PMID: 27724876 PMCID: PMC5057278 DOI: 10.1186/s12884-016-1099-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 10/04/2016] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Depressive symptoms during pregnancy can have multiple adverse effects on perinatal outcomes, including maternal morbidity and mortality. The potential impact of antenatal depressive symptoms on maternal health care use, however, has been little explored in low and middle-income countries (LMICs). This paper investigates whether maternal health care utilisation varies as a function of antenatal depressive symptoms. METHODS In a population-based cross-sectional survey, 1311 women in the second or third trimesters of pregnancy were recruited in Sodo district, Gurage Zone, southern Ethiopia. Depressive symptoms were measured using a locally validated version of the Patient Health Questionnaire (PHQ-9). The association between antenatal depressive symptoms and number of antenatal care (ANC) visits was examined using Poisson regression and the association of depression symptoms with emergency health care visits using negative binomial regression. Binary logistic regression was used to investigate the association of depressive symptoms with initiation, frequency and adequacy of antenatal care. RESULTS At PHQ-9 cut off of five or more, 29.5 % of participants had depressive symptoms. The majority (60.5 %) of women had attended for one or more ANC visits. Women with depressive symptoms had an increased risk of having more non-scheduled ANC visits (adjusted Risk Ratio (aRR) = 1.41, 95 % CI: 1.20, 1.65), as well as an increased number of emergency health care visits to both traditional providers (aRR = 1.64, 95 % CI: 1.17, 2.31) and biomedical providers (aRR = 1.31, 95 % CI: 1.04, 1.69) for pregnancy-related emergencies. However, antenatal depressive symptoms were not significantly associated with initiation of ANC. CONCLUSIONS Increased non-scheduled ANC and emergency health care visits may be indicators of undetected depression in antenatal women, and have the potential to overwhelm the capacity and resources of health care systems, particularly in LMICs. Establishment of a system for detection, referral and treatment of antenatal depression, integrated within existing antenatal care, may reduce antenatal morbidity and treatment costs and promote efficiency of the health care system.
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Affiliation(s)
- Tesera Bitew
- Department of Psychiatry, College of Health Sciences School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Psychology, College of Social Science and Humanities, Debre Markos University, Debre Markos, Ethiopia
| | - Charlotte Hanlon
- Department of Psychiatry, College of Health Sciences School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
- Global Mental Health, Centre for Global Mental Health, Health Services and Population Research Department, Institute of Psychiatry, King’s College London, London, UK
| | - Eskinder Kebede
- Department of Obstetrics and Gynecology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Girmay Medhin
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abebaw Fekadu
- Department of Psychiatry, College of Health Sciences School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia
- Department of Psychological Medicine, Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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18
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Loret de Mola C, Horta BL, Gonçalves H, Quevedo LDA, Pinheiro R, Gigante DP, Dos Santos Motta JV, Barros FC. Breastfeeding and mental health in adulthood: A birth cohort study in Brazil. J Affect Disord 2016; 202:115-9. [PMID: 27261841 PMCID: PMC4957542 DOI: 10.1016/j.jad.2016.05.055] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 05/23/2016] [Accepted: 05/25/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Breastfeeding is negatively associate with behavioral and internalization problems, psychological stress, and depressive/anxiety symptoms. However, studies evaluating specific mental health disorders are scarce. We aimed to assess the association between breastfeeding and mental health outcomes in young adults. METHODS In 1982, hospital deliveries in Pelotas (Southern Brazil) were identified; liveborns were examined and their mothers interviewed (n=5914). Information on breastfeeding was collected in early childhood. In 2012-13, at 30 years of age, we used the Mini International Neuropsychiatric Interview (MINI) for the diagnosis of major depression (MD), generalized anxiety disorder (GAD) and social anxiety disorder (SAD). In addition, we used the Beck Depression Inventory (BDI-II) and the Self-reported Questionnaire (SRQ-20), to evaluate depressive symptoms severity and common mental disorders (CMD), respectively. We used multivariable regression models to evaluate the association between breastfeeding and mental health outcomes. RESULTS We evaluated 3657 individuals. Prevalence of CMD, MD, GAD and SAD was 24.3%, 7.9%, 12.7% and 3.6%, respectively. In multivariable models the odds of having a more severe case of depression (BDI-II) was smaller among those breastfed for 6 or more months (OR=0.69 95%CI [0.53-0.89]). We observed a similar pattern for MD and CMD, however, confidence intervals included the reference. LIMITATIONS We had no information on home environment characteristics during childhood. Lack of power and a small effect size could explain why we did not detect an association between breastfeeding and MD. CONCLUSION Breastfeeding reduced the odds of having more severe depressive symptoms.
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Affiliation(s)
- Christian Loret de Mola
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Brazil; Nursing Department, Federal University of Pelotas, Brazil.
| | | | - Helen Gonçalves
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Brazil
| | - Luciana de Avila Quevedo
- Health and Behavior Postgraduate Program, Universidade Católica de Pelotas - UCPEL, Pelotas, RS, Brazil
| | - Ricardo Pinheiro
- Health and Behavior Postgraduate Program, Universidade Católica de Pelotas - UCPEL, Pelotas, RS, Brazil
| | | | - Janaína Vieira Dos Santos Motta
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Brazil; Health and Behavior Postgraduate Program, Universidade Católica de Pelotas - UCPEL, Pelotas, RS, Brazil
| | - Fernando C Barros
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Brazil; Health and Behavior Postgraduate Program, Universidade Católica de Pelotas - UCPEL, Pelotas, RS, Brazil
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19
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de Quadros LDCM, Laura HC, Quevedo LDA, Gigante DP. [Effects of social mobility on adult mental health:a systematic review of the literature]. CIENCIA & SAUDE COLETIVA 2016; 21:443-8. [PMID: 26910152 DOI: 10.1590/1413-81232015212.17942014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 05/01/2015] [Indexed: 11/21/2022] Open
Abstract
The scope of this study was to identify longitudinal studies evaluating the relationship between social mobility and mental disorders in adults. An electronic review of the literature was conducted in the PubMed/Medline and PsycINFO databases. The bibliographic references of the articles selected for analysis were also examined for eligibility. Cohort studies were selected taking social mobility as exposure category and mental health-related disorders as the outcome. Seven studies were reviewed and their definition and categorization of exposure and outcome were found to be heterogeneous, thus rendering analysis and comparison of the results found in the various studies difficult. Mental health-related disorders were more common in individuals belonging to lower socio-economic classes, regardless of having upward, stable or downward social mobility. Moreover, the influence of individual socio-economic conditions, assessed in adulthood, appears to be greater than the effect of parental economic status on the mental health of individuals. This review indicates that it is possible to find a relationship between socio-economic status during the course of life and mental health in adulthood. However, the direction taken by this relationship remains unclear.
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Affiliation(s)
| | - Helen Castillo Laura
- Centro de Pesquisas Epidemiológicas, Universidade Federal de Pelotas, Pelotas, RS, Brasil,
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20
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Gonçalves H, Pearson RM, Horta BL, González-Chica DA, Castilho E, Damiani M, Lima RC, Gigante DP, Barros FC, Stein A, Victora CG. Maternal depression and anxiety predicts the pattern of offspring symptoms during their transition to adulthood. Psychol Med 2016; 46:415-424. [PMID: 26456404 PMCID: PMC4697191 DOI: 10.1017/s0033291715001956] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 09/03/2014] [Accepted: 09/04/2015] [Indexed: 12/04/2022]
Abstract
BACKGROUND Episodes of depression and anxiety (D&A) during the transition from late adolescence to adulthood, particularly when persistent, are predictive of long-term disorders and associated public health burden. Understanding risk factors at this time is important to guide intervention. The current objective was to investigate the associations between maternal symptoms of D&A with offspring symptoms during their transition to adulthood. METHOD Data from a large population-based birth cohort study, in South Brazil, were used. Prospective associations between maternal D&A and offspring risk of these symptoms during the transition to adulthood (18/19, 24 and 30 years) were estimated. RESULTS Maternal D&A in adolescence was associated with offspring symptoms across the transition to adulthood, associations were consistently stronger for females than for males. Daughters whose mothers reported D&A were 4.6 times (95% confidence interval 2.71-7.84) as likely to report D&A at all three time-points, than daughters of symptom-free mothers. CONCLUSIONS Maternal D&A is associated with persistent D&A during the daughter's transition to adulthood. Intervention strategies should consider the mother's mental health.
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Affiliation(s)
- H. Gonçalves
- Postgraduate Program in Epidemiology,
Universidade Federal de Pelotas,
Pelotas, Rio Grande do Sul,
Brazil
| | - R. M. Pearson
- School of Social and Community Medicine, Bristol
University, UK
- Depertment of Psychiatry,
Oxford Univeristy, UK
| | - B. L. Horta
- Postgraduate Program in Epidemiology,
Universidade Federal de Pelotas,
Pelotas, Rio Grande do Sul,
Brazil
| | - D. A. González-Chica
- Postgraduate Program in Nutrition,
Universidade Federal de Santa Catarina,
Brasil
| | - E. Castilho
- Postgraduate Program in Epidemiology,
Universidade Federal de Pelotas,
Pelotas, Rio Grande do Sul,
Brazil
| | - M. Damiani
- Postgraduate Program in Education,
Universidade Federal de Pelotas, Brasil
| | - R. C. Lima
- Postgraduate Program in Health Science,
Universidade Federal da Grande Dourados, Mato Grosso
do Sul, Brasil
| | - D. P. Gigante
- Postgraduate Program in Epidemiology,
Universidade Federal de Pelotas,
Pelotas, Rio Grande do Sul,
Brazil
| | - F. C. Barros
- Postgraduate Course in Health and
Behavior, Universidade Católica de Pelotas,
Pelotas, Brazil
| | - A. Stein
- Depertment of Psychiatry,
Oxford Univeristy, UK
| | - C. G. Victora
- Postgraduate Program in Epidemiology,
Universidade Federal de Pelotas,
Pelotas, Rio Grande do Sul,
Brazil
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21
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de Quadros LDCM, Quevedo LDA, Motta JVDS, Carraro A, Ribeiro FG, Horta BL, Gigante DP. Social Mobility and Mental Disorders at 30 Years of Age in Participants of the 1982 Cohort, Pelotas, Rio Grande Do Sul - RS. PLoS One 2015; 10:e0136886. [PMID: 26448480 PMCID: PMC4598184 DOI: 10.1371/journal.pone.0136886] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 08/10/2015] [Indexed: 11/23/2022] Open
Abstract
This study aimed to evaluate the relationship between mental disorders at 30 years of age and social mobility by formally testing three hypotheses: Risk Accumulation; Critical Period; and Social Mobility. The study was performed using data from the 30-year follow-up of the Pelotas Birth Cohort Study, conducted in 1982, and data from previous follow-ups. The tool used to evaluate mental health was the Self Report Questionnaire (SRQ-20). For the statistical analysis, the chi-square test with the Yates correction was used to estimate the prevalence of mental disorder, and the Poisson regression with robust variance was used to formally test the hypotheses according to the Risk Accumulation, Critical Period and Social Mobility Models. The analyses were stratified by gender. The prevalence of Common Mental Disorders (CMDs) was 24.3% (95% CI 22.9–25.7) when the whole sample was considered. The highest prevalence, 27.1% (95% CI 25.1–29.2), was found in women, and the difference between genders was significant (p < 0.001). CMDs were more frequent in participants who remained “poor” in the three follow-ups. In both men and women, the best fit was obtained with the Risk Accumulation Model, with p = 0.6348 and p = 0.2105, respectively. The results indicate the need to rethink public income maintenance policies. Finally, we suggest further studies to investigate the role of different public policies in decreasing the prevalence of mental disorders and thus contribute proposals of new policies that may contribute to the prevention of these disorders.
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Affiliation(s)
- Lenice de Castro Muniz de Quadros
- Graduate Program in Epidemiology, Federal University of Pelotas (Universidade Federal de Pelotas - UFPEL), Rio Grande do Sul, Brazil
- * E-mail:
| | - Luciana de Avila Quevedo
- Graduate Program in Health and Behavior, Catholic University of Pelotas (Universidade Católica de Pelotas - UCPel), Rio Grande do Sul, Brazil
| | - Janaína Vieira dos Santos Motta
- Graduate Program in Health and Behavior, Catholic University of Pelotas (Universidade Católica de Pelotas - UCPel), Rio Grande do Sul, Brazil
| | - André Carraro
- Graduate Program in Organizations and Markets, Federal University of Pelotas (Universidade Federal de Pelotas - UFPEL), Rio Grande do Sul, Brazil
| | - Felipe Garcia Ribeiro
- Graduate Program in Organizations and Markets, Federal University of Pelotas (Universidade Federal de Pelotas - UFPEL), Rio Grande do Sul, Brazil
| | - Bernardo Lessa Horta
- Graduate Program in Epidemiology, Federal University of Pelotas (Universidade Federal de Pelotas - UFPEL), Rio Grande do Sul, Brazil
| | - Denise Petrucci Gigante
- Graduate Program in Epidemiology, Federal University of Pelotas (Universidade Federal de Pelotas - UFPEL), Rio Grande do Sul, Brazil
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22
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Reichenheim ME, Moraes CL, Lopes CS, Lobato G. The role of intimate partner violence and other health-related social factors on postpartum common mental disorders: a survey-based structural equation modeling analysis. BMC Public Health 2014; 14:427. [PMID: 24884951 PMCID: PMC4047543 DOI: 10.1186/1471-2458-14-427] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Accepted: 04/15/2014] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Although studies suggest the relevance of intimate partner violence (IPV) and other health-related social characteristics as risk factors for postpartum mental health, literature lacks evidence about how these are effectively connected. This study thus aims to explore how socio-economic position, maternal age, household and marital arrangements, general stressors, alcohol misuse and illicit drug abuse, and especially psychological and physical IPV relate in a framework leading to postpartum common mental disorder (CMD). METHODS The study was carried out in five primary health care units of Rio de Janeiro, Brazil, and included 810 randomly selected mothers of children up to five postpartum months waiting for pediatric visits. The postulated pathways between exposures and outcome were based on literature evidence and were further examined using structural equation models. RESULTS Direct pathways to postpartum CMD arose from a latent variable depicting socio-economic position, a general stressors score, and both IPV variables. Notably, the effect of psychological IPV on postpartum CMD ran partly through physical IPV. The effect of teenage pregnancy, conjugal instability and maternal burden apparently happens solely through substance use, be it alcohol misuse, illicit drug abuse or both in tandem. Moreover, the effect of the latter on CMD seems to be entirely mediated through both types of IPV. CONCLUSION Although the theoretical model underlying the analysis still requires in-depth detailing, results of this study may have shed some light on the role of both psychological and physical IPV as part of an intricate network of events leading to postpartum CMD. Health initiatives may want to make use of this knowledge when designing preventive and intervention approaches.
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Affiliation(s)
- Michael Eduardo Reichenheim
- Department of Epidemiology, Institute of Social Medicine (IMS), Rio de Janeiro State University (UERJ), Rua São Francisco Xavier 524, 7° andar, Rio de Janeiro, RJ 20550-013, Brazil
| | - Claudia Leite Moraes
- Department of Epidemiology, Institute of Social Medicine (IMS), Rio de Janeiro State University (UERJ), Rua São Francisco Xavier 524, 7° andar, Rio de Janeiro, RJ 20550-013, Brazil
- Family Health Master Program, Estácio de Sá University, Rua Riachuelo, 27, Rio de Janeiro, RJ 20230-010, Brazil
| | - Claudia Souza Lopes
- Department of Epidemiology, Institute of Social Medicine (IMS), Rio de Janeiro State University (UERJ), Rua São Francisco Xavier 524, 7° andar, Rio de Janeiro, RJ 20550-013, Brazil
| | - Gustavo Lobato
- Fernandes Figueira Institute, Oswaldo Cruz Foundation (FIOCRUZ), Avenida Rui Barbosa, 716 – 3° Andar, Rio de Janeiro, RJ 22250-020, Brazil
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23
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Munhoz TN, Santos IS, Matijasevich A. Major depressive episode among Brazilian adults: a cross-sectional population-based study. J Affect Disord 2013; 150:401-7. [PMID: 23688916 DOI: 10.1016/j.jad.2013.04.031] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 04/19/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Despite the fact that there is extensive scientific research on depression very few population-based studies have been conducted in Brazilian cities. METHODS A sampling design of two-stage conglomerates with probability proportional to size. All adults aged 20 or more living in the selected households were invited to participate in the study. Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9) with a cutoff ≥9. RESULTS The study sample comprised 2925 respondents. The prevalence of depression in the sample studied was 20.4% (95% CI 18.9;21.8). After adjustment for confounding factors according to a conceptual analysis model the following variables were associated with a higher prevalence of depression: female gender; younger age; white skin color; lower socioeconomic condition; lower education; smoking; being single or separated; being unemployed; and reporting a heart condition. Alcohol use, arterial hypertension, and diabetes mellitus were not found to be associated with depression. LIMITATIONS The difference in the proportion of males among losses and refusals compared to that in the sample analyzed. Another limitation is reverse causality bias that is a problem inherent to cross-sectional studies. CONCLUSIONS Our findings support the relevance of depression as a prevalent condition among adults. It also provided evidence of the factors associated with depression, and that some are potentially modifiable risk factors may have implications for policy and health service planning.
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Affiliation(s)
- Tiago N Munhoz
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.
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Fryers T, Brugha T. Childhood determinants of adult psychiatric disorder. Clin Pract Epidemiol Ment Health 2013; 9:1-50. [PMID: 23539489 PMCID: PMC3606947 DOI: 10.2174/1745017901309010001] [Citation(s) in RCA: 146] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Revised: 06/22/2012] [Accepted: 07/07/2012] [Indexed: 02/06/2023]
Abstract
The aim of this project was to assess the current evidence from longitudinal studies for childhood determinants of adult mental illness. Because of the variable and often prolonged period between factors in childhood and the identification of mental illness in adults, prospective studies, particularly birth cohorts, offer the best chance of demonstrating associations in individuals. A review was undertaken in 2006 of the published literature from longitudinal studies, together with some large-scale retrospective studies and relevant reviews which provided supplementary evidence. The main focus was upon potentially ameliorable characteristics, experiences or situations of childhood; however, other factors, not determinants but pre-cursors, associated with later mental illness could not be left out. Seven major electronic data-bases of published research were interrogated with a range of key-words and the results supplemented from personal searches, enquiries and reference trails. In excess of 1,500 abstracts were read to select 250 papers for full review. The material was assessed in relation to ten factors: Psychological disturbance; Genetic Influences; Neurological Deviance; Neuroticism; Behaviour; School Performance; Adversity; Child Abuse or Neglect; Parenting and parent-child relationships; Disrupted and Disfunctional Families. In 2011 the search was repeated for the period 2006 to mid-2011, using the same search terms and supplemented in the same manner. Over 1,800 abstracts emerged and almost 200 papers selected for more detailed review. These were then integrated into the original text with modifications where necessary. The whole text was then revised and edited in January / February 2012. There is continuing evidence for the association with later mental ill-health for each of these ten factors, but with different degrees of conviction. The evidence for each is discussed in detail and weighed both separately and in relation to others. These are then summarised, and the research implications are considered. Finally, the implications for prevention are discussed together with the practical potential for preventive and health-promoting programmes.
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Affiliation(s)
- Tom Fryers
- International and Public Health, School of Health Sciences, New York Medical College, USA ; Department of Health Sciences, University of Leicester, UK
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Pereira TS, Silva AA, Alves MT, Simões VM, Batista RF, Rodriguez JD, Figueiredo FP, Lamy-Filho F, Barbieri MA, Bettiol H. Perinatal and early life factors associated with symptoms of depression in Brazilian children. BMC Public Health 2012; 12:605. [PMID: 22863172 PMCID: PMC3487932 DOI: 10.1186/1471-2458-12-605] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 07/27/2012] [Indexed: 11/13/2022] Open
Abstract
Background Few studies have been conducted on the association between perinatal and early life factors with childhood depression and results are conflicting. Our aim was to estimate the prevalence and perinatal and early life factors associated with symptoms of depression in children aged 7 to 11 years from two Brazilian birth cohorts. Methods The study was conducted on 1444 children whose data were collected at birth and at school age, in 1994 and 2004/2005 in Ribeirao Preto, where they were aged 10–11 years and in 1997/98 and 2005/06 in São Luís, where children were aged 7–9 years. Depressive symptoms were investigated with the Child Depression Inventory(CDI), categorized as yes (score ≥ 20) and no (score < 20). Adjusted and non-adjusted prevalence ratios (PR) were estimated by Poisson regression with robust estimation of the standard errors. Results The prevalence of depressive symptoms was 3.9% (95%CI = 2.5-5.4) in Ribeirão Preto and 13.7% (95%CI = 11.0-16.4) in São Luís. In the adjusted analysis, in Ribeirão Preto, low birth weight (PR = 3.98; 95%CI = 1.72-9.23), skilled and semi-skilled manual occupation (PR = 5.30; 95%CI = 1.14-24.76) and unskilled manual occupation and unemployment (PR = 6.65; 95%CI = 1.16-38.03) of the household head were risk factors for depressive symptoms. In São Luís, maternal schooling of 0–4 years (PR = 2.39; 95%CI = 1.31-4.34) and of 5 to 8 years (PR = 1.80; 95%CI = 1.08-3.01), and paternal age <20 years (PR = 1.92; 95%CI = 1.02-3.61), were independent risk factors for depressive symptoms. Conclusions The prevalence of depressive symptoms was much higher in the less developed city, São Luís, than in the more developed city, Ribeirão Preto, and than those reported in several international studies. Low socioeconomic level was associated with depressive symptoms in both cohorts. Low paternal age was a risk factor for depressive symptoms in the less developed city, São Luís, whereas low birth weight was a risk factor for depressive symptoms in the more developed city, Ribeirão Preto.
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Affiliation(s)
- Thaís S Pereira
- Department of Public Health, Federal University of Maranhão, São Luís, MA, Brazil
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26
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Guiltinan AM, Kaidarova Z, Behan D, Marosi C, Hutching S, Kaiser M, Moore E, Devita D, Murphy EL. Major depression and generalized anxiety disorder among human T-lymphotropic virus types I- and II-infected former blood donors. Transfusion 2012; 53:60-8. [PMID: 22554308 DOI: 10.1111/j.1537-2995.2012.03677.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Other studies have reported high rates of depression and anxiety among human T-lymphotropic virus Type I (HTLV-I)-infected subjects and have even suggested that HTLV-I causes psychiatric disease. STUDY DESIGN AND METHODS We interviewed HTLV-I, HTLV-II, and demographically similar HTLV-seronegative blood donors with the Mini-International Neuropsychiatric Interview. Prevalences of major depression and generalized anxiety disorder in each group were calculated and compared to published US population data. Adjusted odds ratios (aOR) and 95% confidence intervals (CIs) controlling for educational achievement, alcohol intake, and self-reported health status were calculated with multivariate logistic regression. RESULTS Major depression was diagnosed in five (5.4%) of 93 HTLV-I-positive subjects (aOR, 2.19; 95% CI, 0.63-7.55) and 17 (6.6%) of 256 HTLV-II-positive subjects (aOR, 1.61; 95% CI, 0.66-3.927), compared to 12 (2.1%) of 585 HTLV-seronegative blood donors. The prevalence of major depression among infected subjects was comparable to the 6.7% prevalence in the US general population. Generalized anxiety disorder was diagnosed in five (5.4%) HTLV-I-positive subjects (OR, 2.32; 95% CI, 0.74-7.26) and 12 (4.7%) HTLV-II-positive subjects (OR, 1.65; 95% CI, 0.68-4.01), compared to 15 (2.6%) seronegative subjects and 3.1% in the US general population. CONCLUSION Major depression and generalized anxiety disorder were not significantly more prevalent among HTLV-I- and HTLV-II-infected former blood donors after controlling for health status and other confounding variables. HTLV-seronegative blood donors had lower prevalences of these conditions than the US population, probably due to a "healthy blood donor effect."
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Gallo EAG, Anselmi L, Dumith SC, Scazufca M, Menezes AMB, Hallal PC, Matijasevich A. Tamanho ao nascer e problemas de saúde mental aos 11 anos em uma coorte brasileira de nascimentos. CAD SAUDE PUBLICA 2011; 27:1622-32. [DOI: 10.1590/s0102-311x2011000800017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Accepted: 06/01/2011] [Indexed: 11/21/2022] Open
Abstract
O objetivo foi avaliar a associação entre tamanho ao nascer e problemas de saúde mental aos 11 anos na Coorte de Nascimentos de Pelotas, Rio Grande do Sul, Brasil, de 1993. Foram pesados e medidos ao nascer 4.358 recém-nascidos. Avaliou-se problemas de saúde mental com o questionário de capacidades e dificuldades (Strengths and Difficulties Questionnaire - SDQ). A prevalência de problemas de saúde mental foi de 32% (IC95%: 31-33). Na análise ajustada, os 291 (6,7%) recém-nascidos com escorez de peso/idade e os 268 (6,2%) com índice de massa corporal (IMC)/idade < -2 DP tiveram, respectivamente, 27% (IC95%: 7-49) e 29% (IC95%: 10-51) maior risco de apresentar problemas de saúde mental aos 11 anos quando comparados com aqueles com escore normal. Os 102 (2,43%) recém-nascidos com escorez de IMC e os 279 (6,4%) com perímetro cefálico/idade > +2 DP tiveram, respectivamente, 34% (IC95%: 6-71) e 19% (IC95%: 1-40) maior risco de apresentar esses problemas se comparados com aqueles com escore normal. Os resultados sugerem que fatores ocorridos na gestação e refletidos nas medidas de tamanho ao nascer podem ocasionar problemas de saúde mental em etapas tardias.
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Affiliation(s)
| | | | | | | | | | - Pedro C. Hallal
- Universidade Federal de Pelotas, Brasil; Universidade Federal de Pelotas, Brasil
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Rocha SV, Almeida MMGD, Araújo TM, Virtuoso Júnior JS. Atividade física no lazer e transtornos mentais comuns entre idosos residentes em um município do nordeste do Brasil. JORNAL BRASILEIRO DE PSIQUIATRIA 2011. [DOI: 10.1590/s0047-20852011000200002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVO: Analisar a associação entre atividade física no lazer e a prevalência de transtornos mentais comuns entre idosos. MÉTODOS: Estudo transversal com amostra constituída de 562 indivíduos residentes no município de Feira de Santana, 69,6% do sexo feminino e 30,4% do sexo masculino, com média de idade de 68,93 ± 7,05 anos. Foi utilizado um formulário com informações sociodemográficas, doenças referidas, triagem para transtornos mentais comuns (TMC) utilizando o Self-Reporting Questionnaire (SRQ-20). Participação em atividade física no lazer foi avaliada segundo autopercepção do tipo e da intensidade da atividade (leve, moderada ou pesada). Para análise estatística, foi utilizada a técnica de regressão logística, com o cálculo das razões de prevalência, intervalo de confiança (95%) e nível de significância p < 0,05. RESULTADOS: Dentre os indivíduos estudados, 18,3% foram classificados como ativos no lazer. A prevalência de TMC foi de 32,1%, sendo menor entre os indivíduos ativos no lazer (RP = 0,49; IC = 0,29-0,84), após ajuste por faixa etária e renda. CONCLUSÃO: Há elevada proporção de inativos no lazer, e essa condição está associada à maior prevalência de TMC. Sugere-se que ações direcionadas à saúde mental priorizem programas que favoreçam o incentivo à prática de atividade física entre os idosos residentes no município, tendo em vista a contribuição desse comportamento no tratamento e na prevenção de morbidades psíquicas.
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Rocha SV, Almeida MMGD, Araújo TMD, Virtuoso Júnior JS. Prevalência de transtornos mentais comuns entre residentes em áreas urbanas de Feira de Santana, Bahia. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2010; 13:630-40. [DOI: 10.1590/s1415-790x2010000400008] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Accepted: 09/01/2010] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Descrever a prevalência de transtornos mentais comuns segundo características sociodemográficas, hábitos de vida e presença de doenças crônicas entre residentes em áreas urbanas de Feira de Santana, Bahia. MÉTODOS: Trata-se de um estudo epidemiológico de corte transversal com amostra da população de 15 anos ou mais de idade de Feira de Santana, aleatoriamente selecionada. Foi utilizado um formulário, contendo informações sociodemográficas, de hábitos de vida e doenças referidas. O SRQ-20 foi utilizado para mensuração de Transtornos Mentais Comuns (TMC). A análise estatística foi realizada com nível de significância p < 0,05, cálculo da razão de prevalência e intervalos de confiança de 95%. RESULTADOS: Foram estudados 3.597 indivíduos, 71,4% do sexo feminino. A prevalência global de TMC foi de 29,9%. A análise dos dados revelou que as características sociodemográficas (sexo, renda e escolaridade), os hábitos de vida e as condições clínicas estavam associados à maior prevalência de TMC. CONCLUSÕES: O estudo permitiu estimar a prevalência de TMC na população urbana de um município localizado no nordeste do Brasil e identificar características associadas aos TMC que podem interferir na saúde mental da população estudada. Nesse sentido, as políticas de atenção a saúde mental do município devem contemplar ações direcionadas ao incentivo a participação em atividades de lazer além de campanhas de controle do uso de tabaco e doenças crônicas.
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Béhague DP, Gonçalves H. [Exploring multiple trajectories of causality: collaboration between Anthropology and Epidemiology in the 1982 birth cohort, Pelotas, Southern Brazil]. Rev Saude Publica 2009; 42 Suppl 2:115-23. [PMID: 19142353 DOI: 10.1590/s0034-89102008000900016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2008] [Accepted: 10/22/2008] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Although the relationship between epidemiology and anthropology has a long history, it has generally been comprised of the integration of quantitative and qualitative methods. Only recently have the two fields begun to converge along theoretical lines, leading to a growing mutual interest in explaining rather than simply describing phenomena. This paper aimed to illustrate how ethnographic analyses can be used to assist with the in-depth and theoretically-imbued interpretation of epidemiological results. METHODS The anthropological analysis presented in this paper used ethnographic data collected as part of the ongoing 1982 birth cohort study, between 1997 and 2007 in Pelotas, Southern Brazil. Analyses were framed according to the results presented in two of the epidemiological articles published in this series on the determinants of mental morbidity and age of sexual initiation. RESULTS AND CONCLUSIONS The ethnographic results show that statistical associations consist of multiple pathways of influence and causality that generally correspond to the unique experiences of specific subgroups. In exploring these pathways, the paper highlights the importance of an additional set of mediating factors that account for epidemiological results; these include the awareness and experience of inequities, the role of violence in everyday life, traumatic life events, increasing social isolation and emotional introversion as a response to life's difficulties, and differing approaches towards socio-psychological maturation. Theoretical and methodological collaboration between anthropology and epidemiology is important for public health, as it has positively modified both fields.
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Affiliation(s)
- Dominique P Béhague
- London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom.
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