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da Silva HC, Vilete L, Coutinho ESF, Luz MP, Mendlowicz M, Portela CM, Figueira I, Ventura P, Mari JDJ, Quintana MI, Ribeiro WS, Andreoli SB, Berger W. The role of childhood cumulative trauma in the risk of lifetime PTSD: An epidemiological study. Psychiatry Res 2024; 336:115887. [PMID: 38642421 DOI: 10.1016/j.psychres.2024.115887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 03/11/2024] [Accepted: 03/29/2024] [Indexed: 04/22/2024]
Abstract
Cumulative trauma is usually devastating and can lead to severe psychological consequences, including posttraumatic stress disorder (PTSD). Exposure to various types of traumas, particularly during childhood, can be even more deleterious than the sheer number of events experienced. This epidemiological study is the first to investigate the impact of discrete childhood traumatic exposure on the risk of developing lifetime PTSD in a representative sample of the general population of the two biggest Brazilian cities. Participants were aged between 15 and 75 years old, living in São Paulo and Rio de Janeiro, Brazil, who had experienced traumatic events (N = 3,231). The PTSD diagnosis was assessed using the DSM-IV criteria through the version 2.1 of Composite International Diagnostic Interview. To operationalize childhood cumulative trauma, we considered the sum of 15 different childhood trauma categories that occurred before PTSD onset. The final multivariate logistic regression model indicated a strong relationship between the number of discrete types of childhood traumas and the likelihood of the lifetime PTSD development. The lifetime PTSD risk increased 28 % with each different type of childhood trauma when adjusted by confounds. Our study strengthens the evidence associating childhood cumulative trauma to increased lifetime PTSD risk.
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Affiliation(s)
- Herika Cristina da Silva
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Liliane Vilete
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Mariana Pires Luz
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mauro Mendlowicz
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; Department of Psychiatry and Mental Health, Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | - Carla Marques Portela
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ivan Figueira
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Paula Ventura
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jair de Jesus Mari
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil; Health Service and Population Research Department, King's College London, Institute of Psychiatry, London, United Kingdom
| | - Maria Inês Quintana
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Wagner Silva Ribeiro
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, United Kingdom
| | | | - William Berger
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Ismael F, Ramos A, de Menezes RE, Grespam RMZ, Sequeira CCR, Mari JDJ, Castaldelli-Maia JM. Addressing Mental Health Needs in Low- and Middle-Income Countries: The case of São Caetano do Sul, Brazil. Trends Psychiatry Psychother 2024. [PMID: 38696302 DOI: 10.47626/2237-6089-2023-0674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 04/29/2024] [Indexed: 05/04/2024]
Abstract
São Caetano do Sul, a city in southeastern Brazil, boasts exemplary social indicators and healthcare services, with a population of 162,763 and a density of 9,736.03 inhabitants/km². Allocating 25% of its budget to healthcare, the city's mental healthcare services adhere to the National Mental Health Policy. Structured services include a CAPS-II, CAPS-AD, outpatient teams, and teams in various locations. Initiatives since 2000 include inaugurating a CAPS-AD in 2006, a psychiatric emergency service in 2010, and a CAPS-II in 2016, relocating CAPS-AD in 2019, and establishing the Cuca Legal Project in 2022. São Caetano do Sul has a Mental Health Risk Classification Protocol to aid clinical decision-making. Developing care lines for various groups, it offers programs like smoking prevention, school psychology, and obesity support. Collaborating with community centers, these facilities serve as teaching environments. The mental health care network focuses on five axes: Communication, Care, Prevention, Management, and Education, with specific proposed actions and competencies. Despite progress, challenges remain. Expanding access, reducing stigma, and implementing robust monitoring are crucial. São Caetano do Sul's experience offers valuable insights for similar urban settings in LMICs developing mental health programs.
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Affiliation(s)
- Flavia Ismael
- Section of Mental Health, Department of Health, São Caetano do Sul, SP, Brazil. Municipal University of São Caetano do Sul (USCS), São Caetano do Sul, SP, Brazil
| | - Artur Ramos
- Psychosocial Care Center for Substance Use Disorders Butantã (CAPS-AD Butantã), São Paulo, SP, Brazil
| | | | - Regina Maura Zetone Grespam
- Section of Mental Health, Department of Health, São Caetano do Sul, SP, Brazil. Municipal University of São Caetano do Sul (USCS), São Caetano do Sul, SP, Brazil
| | - Cibele Cristine Remondes Sequeira
- Section of Mental Health, Department of Health, São Caetano do Sul, SP, Brazil. Municipal University of São Caetano do Sul (USCS), São Caetano do Sul, SP, Brazil
| | - Jair de Jesus Mari
- Department of Psychiatry, Federal University of São Paulo, São Paulo, SP, Brazil
| | - João Mauricio Castaldelli-Maia
- Department of Neuroscience, Medical School, FMABC University Center, Santo André, SP, Brazil. Department of Psychiatry, Medical School, University of São Paulo, São Paulo, SP, Brazil. Instituto Perdizes (IPer), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Leusin F, Damiano RF, Mendes LST, Hoffmann MS, Manfro AG, Pan PM, Gadelha A, de Jesus Mari J, Manfro GG, Miguel EC, Rohde LA, Bressan RA, Salum GA. Perinatal and neonatal factors and mental disorders in children and adolescents: looking for the contributions of the early environment to common and dissociable aspects of psychopathology. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02402-0. [PMID: 38519607 DOI: 10.1007/s00787-024-02402-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 02/17/2024] [Indexed: 03/25/2024]
Abstract
High rates of co-occurrence of mental disorders have been hypothesized to represent a result of common susceptibility to overall psychopathology. The purpose of this study is to test the hypothesis that commonalities among psychiatric disorders might be partially driven by sharable perinatal and neonatal environmental factors for mental disorders. Participants were 6-14 years of age children and their parents. Primary caregivers provided data on perinatal and neonatal information assessed retrospectively (n = 2231). Psychiatric disorders diagnoses were assessed using the Development and Well Being Behavior Assessment (DAWBA). We used bifactor models to disentangle common from dissociable aspects of psychopathology. These models allow modeling psychiatric disorders as the result of a common domain of psychopathology (p-factor) and three dissociable domains (fear, distress, and externalizing symptoms). Associations were tested using linear and tobit regression models. The p-factor was associated with male sex, low socioeconomic status, gestational smoking, gestational drinking, low levels of maternal education and presence of mental disorder in the mother. Associations with specific factors also emerged suggesting some risk factors might also have some role for fear, distress and externalizing factors. Our study supports the hypothesis that overall susceptibility to psychopathology might be partially driven by sharable perinatal and neonatal factors.
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Affiliation(s)
- Fabiane Leusin
- Section On Negative Affect and Social Process, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil
| | - Rodolfo Furlan Damiano
- National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil.
- Instituto de Psiquiatria da Faculdade de Medicina da USP, Rua Ovídio Pires de Campos, 785-Cerqueira César, São Paulo, SP, 05403-903, Brazil.
| | - Lorenna Sena Teixeira Mendes
- Section On Negative Affect and Social Process, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil
| | - Maurício Scopel Hoffmann
- Department of Neuropsychiatry, Universidade Federal de Santa Maria (UFSM), Camobi, Brazil
- Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Mental Health Epidemiology Group (MHEG), Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
- London School of Economics and Political Science, Care Policy and Evaluation Centre, London, UK
| | - Arthur Gus Manfro
- Section On Negative Affect and Social Process, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil
| | - Pedro Mario Pan
- National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil
- Departamento de Psiquiatria da Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Ary Gadelha
- National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil
- Departamento de Psiquiatria da Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Jair de Jesus Mari
- National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil
- Departamento de Psiquiatria da Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Gisele Gus Manfro
- Section On Negative Affect and Social Process, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil
| | - Eurípedes Constantino Miguel
- National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil
- Instituto de Psiquiatria da Faculdade de Medicina da USP, Rua Ovídio Pires de Campos, 785-Cerqueira César, São Paulo, SP, 05403-903, Brazil
| | - Luis Augusto Rohde
- Section On Negative Affect and Social Process, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil
| | - Rodrigo Affonseca Bressan
- National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil
- Departamento de Psiquiatria da Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Giovanni Abrahão Salum
- Section On Negative Affect and Social Process, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil
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Bordini D, Moya AC, Asevedo GRDC, Paula CS, Brunoni D, Brentani H, Caetano SC, Mari JDJ, Bagaiolo L. Exploring the Acquisition of Social Communication Skills in Children with Autism: Preliminary Findings from Applied Behavior Analysis (ABA), Parent Training, and Video Modeling. Brain Sci 2024; 14:172. [PMID: 38391746 PMCID: PMC10886593 DOI: 10.3390/brainsci14020172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 02/01/2024] [Accepted: 02/03/2024] [Indexed: 02/24/2024] Open
Abstract
Social communication skills, especially eye contact and joint attention, are frequently impaired in autism spectrum disorder (ASD) and predict functional outcomes. Applied behavior analysis is one of the most common evidence-based treatments for ASD, but it is not accessible to most families in low- and middle-income countries (LMICs) as it is an expensive and intensive treatment and needs to be delivered by highly specialized professionals. Parental training has emerged as an effective alternative. This is an exploratory study to assess a parental intervention group via video modeling to acquire eye contact and joint attention. Four graded measures of eye contact and joint attention (full physical prompt, partial physical prompt, gestural prompt, and independent) were assessed in 34 children with ASD and intellectual disability (ID). There was a progressive reduction in the level of prompting required over time to acquire eye contact and joint attention, as well as a positive correlation between the time of exposure to the intervention and the acquisition of abilities. This kind of parent training using video modeling to teach eye contact and joint attention skills to children with ASD and ID is a low-cost intervention that can be applied in low-resource settings.
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Affiliation(s)
- Daniela Bordini
- Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo 04017-030, SP, Brazil
| | - Ana Cláudia Moya
- Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo 04017-030, SP, Brazil
| | | | - Cristiane Silvestre Paula
- Human Development Sciences Program, Mackenzie Presbyterian University (UPM), Sao Paulo 01302-907, SP, Brazil
| | - Décio Brunoni
- Human Development Sciences Program, Mackenzie Presbyterian University (UPM), Sao Paulo 01302-907, SP, Brazil
| | - Helena Brentani
- Psychiatry Institute, University of São Paulo (USP), Sao Paulo 01246-904, SP, Brazil
| | - Sheila Cavalcante Caetano
- Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo 04017-030, SP, Brazil
| | - Jair de Jesus Mari
- Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo 04017-030, SP, Brazil
| | - Leila Bagaiolo
- Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo 04017-030, SP, Brazil
- Gradual-Behavioral Intervention Group, Sao Paulo 05458-000, SP, Brazil
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Diniz EJB, Scorza FA, Rodrigues FMS, de Mello CB, Bonetti TCDS, Bortoluci KR, Mari JDJ. The impact of inflammatory and metabolic markers on depression, anxiety, and cognition after COVID-19: A narrative review. Trends Psychiatry Psychother 2023. [PMID: 37368949 DOI: 10.47626/2237-6089-2022-0599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023]
Abstract
INTRODUCTION There has been growing concern about the long-term effects of COVID-19 on mental health. The biological factors common to psychiatric conditions and COVID-19 are not yet fully understood. METHODOLOGY We narratively reviewed prospective longitudinal studies that measured metabolic or inflammatory markers and assessed psychiatric sequalae and cognitive impairment in individuals with COVID-19 at least 3 months after the infection. A literature search identified three relevant cohort studies. RESULTS Overall, depressive symptomatology and cognitive deficits persisted for up to one year after COVID-19; depression and cognitive changes were predicted by acute inflammatory markers, and changes in these markers correlated with changes in depressive symptomatology; female sex, obesity, and the presence of inflammatory markers were associated with more severe clusters of physical and mental health status in patients' self-perceived recovery; and plasma metabolic profiles of patients continued to differ from those of healthy controls three months after hospital discharge, which were associated with widespread alterations in neuroimaging, reflecting issues with white matter integrity. This is a non-systematic review and cautions should be made while interpreting the conclusions. CONCLUSION In individuals affected by the COVID-19, prolonged exposure to stress and alterations in metabolic and inflammatory markers plays a central role in psychiatric sequalae and cognitive deficits in the long term.
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Affiliation(s)
- Elton Jorge Bessa Diniz
- Department of Psychiatry and Psychological Medicine, Universidade Federal de São Paulo, SP, Brazil
| | - Fulvio Alexandre Scorza
- Departamento de Neurologia/Neurocirurgia Escola Paulista de Medicina, Universidade Federal de São Paulo, SP, Brazil
| | | | | | | | - Karina Ramalho Bortoluci
- Departamento de Farmacologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, SP, Brazil
| | - Jair de Jesus Mari
- Department of Psychiatry and Psychological Medicine, Universidade Federal de São Paulo, SP, Brazil
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Romani-Sponchiado A, Vidal-Ribas P, Bressan RA, de Jesus Mari J, Miguel EC, Gadelha A, Rohde LAP, Evans-Lacko S, Salum GA, Hoffmann MS. Longitudinal associations between positive attributes and psychopathology and their interactive effects on educational outcomes. Eur Child Adolesc Psychiatry 2023; 32:463-474. [PMID: 34559317 DOI: 10.1007/s00787-021-01882-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 09/15/2021] [Indexed: 11/26/2022]
Abstract
Psychopathology is associated with impaired learning and early termination of schooling, whereas positive attributes are associated with better educational outcomes. However, it is important to understand if and how psychopathology and positive attributes longitudinally impact each other so we could shed light on where to intervene to promote educational outcomes through these constructs. A large prospective school-based community cohort of youths (5-15 years of age, 45% female) were assessed and followed up for 3 years (n = 2010; 80% retention). We assessed the longitudinal impact of positive attributes (Youth Strength Inventory) and psychopathology (bifactor model of Strengths and Difficulties Questionnaire) using a cross-lagged panel model. We also used generalized mixed effects models to investigate how these both constructs predict school dropout and literacy, adjusting for confounders and testing their interaction. Positive attributes negatively predicted, and were negatively predicted by, the general factor of psychopathology and conduct problems in the cross-lagged panel model. Positive attributes (OR = 0.57, 95% CI [0.44, 0.73], p < 0.001) and specific conduct symptoms (OR = 2.33, 95% CI [1.64, 3.33], p < 0.001) predicted school dropout, whereas the general factor of psychopathology predicted lower literacy ability (β = - 0.08, 95% CI [- 0.11, - 0.05], p < 0.001). However, the protective association of positive attributes on school dropout decreases as the general factor of psychopathology increases. These findings provide new evidence that positive attributes and psychopathology mutually influence each other over development and have interactive effects on educational outcomes.
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Affiliation(s)
- Aline Romani-Sponchiado
- Universidade Federal Do Rio Grande Do Sul, Ramiro Barcelos, 2350 - room 2202, Porto Alegre, 90035-003, Brazil.
- Section On Negative Affect and Social Processes, Hospital de Clínicas de Porto Alegre, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, RS, Brazil.
| | - Pablo Vidal-Ribas
- Social and Behavioral Science Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, USA
| | - Rodrigo Affonseca Bressan
- National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, SP, Brazil
- Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Jair de Jesus Mari
- National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, SP, Brazil
- Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Eurípedes Constantino Miguel
- National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, SP, Brazil
- Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Ary Gadelha
- Laboratory of Integrative Neuroscience (LINC), Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Luis Augusto Paim Rohde
- Universidade Federal Do Rio Grande Do Sul, Ramiro Barcelos, 2350 - room 2202, Porto Alegre, 90035-003, Brazil
- National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, SP, Brazil
- ADHD Outpatient Program & Developmental Psychiatry Program, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande Do Sul, Porto Alegre, RS, Brazil
| | - Sara Evans-Lacko
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Giovanni Abrahão Salum
- Universidade Federal Do Rio Grande Do Sul, Ramiro Barcelos, 2350 - room 2202, Porto Alegre, 90035-003, Brazil
- Section On Negative Affect and Social Processes, Hospital de Clínicas de Porto Alegre, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, RS, Brazil
- National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, SP, Brazil
| | - Mauricio Scopel Hoffmann
- Universidade Federal Do Rio Grande Do Sul, Ramiro Barcelos, 2350 - room 2202, Porto Alegre, 90035-003, Brazil
- Section On Negative Affect and Social Processes, Hospital de Clínicas de Porto Alegre, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, RS, Brazil
- National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, SP, Brazil
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
- Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
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Hoffmann MS, Rocha KB, Evans-Lacko S, Gosmann NP, Becker N, Magalhães PVDS, Razzouk D, Spanemberg L, Fleck MPDA, Mari JDJ, Thornicroft G, Salum GA. Latent structure and factor reliability of the National Health Service Community Mental Health Service User Questionnaire. J Ment Health 2022; 31:809-815. [PMID: 33978546 DOI: 10.1080/09638237.2021.1922655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND National Health Service use the Community Mental Health Service User Questionnaire (NHS-CMH) to assess care quality. However, its reliability and internal validity is uncertain. AIMS To test the NHS-CMH structure, reliability and item-level characteristics. METHODS We used data from 11,373 participants who answered the 2017 NHS-CMH survey. First, we estimated the NHS-CMH structure using Exploratory Factor Analysis (EFA) in half of the dataset. Second, we tested the best EFA-derived model with Confirmatory Factor Analysis (CFA). We tested the internal validity, construct reliability (omega - ω), explained common variance of each factor (ECV), and item thresholds. RESULTS EFA suggested a 4-factor solution. The structure derived from the EFA was confirmed, demonstrating good reliability for the four correlated dimensions: "Relationship with Staff" (ω = 0.952, ECV = 40.1%), "Organizing Care" (ω = 0.855, ECV = 21.4%), "Medication and Treatments" (ω = 0.837, ECV = 13.3%), and "Support and Well-being" (ω = 0.928, ECV = 25.3%). A second-order model with a high-order domain of "Quality of Care" is also supported. CONCLUSIONS The NHS-CMH can be used to reliably assess four user-informed dimensions of mental health care quality. This model offers an alternative for its current use (item-level and untested sum scores analysis).
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Affiliation(s)
- Mauricio Scopel Hoffmann
- Graduate Program in Psychiatry and Behavioral Sciences, Centro de Pesquisa Clínica, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Departamento de Neuropsiquiatria, Universidade Federal de Santa Maria, Santa Maria, Brazil.,National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil.,Care Policy and Evaluation Centre, London School of Economics and Political Science, London, United Kingdom
| | - Katia Bones Rocha
- Graduate Program in Psychiatry and Behavioral Sciences, Centro de Pesquisa Clínica, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Sara Evans-Lacko
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, United Kingdom
| | - Natan Pereira Gosmann
- Graduate Program in Psychiatry and Behavioral Sciences, Centro de Pesquisa Clínica, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Natalia Becker
- Graduate Program in Psychiatry and Behavioral Sciences, Centro de Pesquisa Clínica, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Pedro Vieira da Silva Magalhães
- Graduate Program in Psychiatry and Behavioral Sciences, Centro de Pesquisa Clínica, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Denise Razzouk
- Department of Psychiatry, Univerisdade Federal de São Paulo, São Paulo, Brazil
| | - Lucas Spanemberg
- Graduate Program in Psychiatry and Behavioral Sciences, Centro de Pesquisa Clínica, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Marcelo Pio de Almeida Fleck
- Graduate Program in Psychiatry and Behavioral Sciences, Centro de Pesquisa Clínica, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Jair de Jesus Mari
- National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil.,Department of Psychiatry, Univerisdade Federal de São Paulo, São Paulo, Brazil
| | - Graham Thornicroft
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Giovanni Abrahão Salum
- Graduate Program in Psychiatry and Behavioral Sciences, Centro de Pesquisa Clínica, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil
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Cumbe VFJ, Greene C, Fumo AMT, Fumo H, Mabunda D, Gouveia LC, Oquendo MA, Duarte CS, Sidat M, Mari JDJ. Community Health Workers' Knowledge, Attitudes, and Practices towards Epilepsy in Sofala, Central Mozambique. Int J Environ Res Public Health 2022; 19:15420. [PMID: 36430139 PMCID: PMC9693375 DOI: 10.3390/ijerph192215420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/22/2022] [Accepted: 07/26/2022] [Indexed: 05/14/2023]
Abstract
BACKGROUND Epilepsy is the most common neurological disease in the world, affecting 50 million people, with the majority living in low- and middle-income countries (LMICs). A major focus of epilepsy treatment in LMICs has been task-sharing the identification and care for epilepsy by community health workers (CHWs). The present study aimed to assess the knowledge, attitudes, and practices (KAPs) of CHWs towards epilepsy in Mozambique. METHODS One hundred and thirty-five CHWs completed a questionnaire that included socio-demographic characteristics and 44-items divided into six subscales pertaining to KAPs towards epilepsy (QKAP-EPI) across nine districts of Sofala, Mozambique. The internal consistency was examined to evaluate the reliability of the instrument (QKAP-EPI). The association between sociodemographic variables and QKAP-EPI subscales was examined using linear regression models. RESULTS The internal consistency was moderate for two subscales (causes of epilepsy, α = 0.65; medical treatment, α = 0.694), acceptable for cultural treatment (α = 0.797) and excellent for 2 subscales (safety and risks, α = 0.926; negative attitudes, α = 0.904). Overall, CHWs demonstrated accurate epilepsy knowledge (medical treatment: mean = 1.63, SD = 0.28; safety/risks: mean = 1.62, SD = 0.59). However, CHWs reported inaccurate epilepsy knowledge of the causes, negative attitudes, as well as culturally specific treatments for epilepsy, such as: "if a person with epilepsy burns when set on fire they cannot be treated". Knowledge about how to manage epileptic seizures varied across the different emergency care practices, from the accurate belief that it is not advisable to place objects in the individual's mouth during an epileptic seizure, to the wrong perception of the need to hold the person in seizures to control seizures. Heterogeneity in the level of epilepsy knowledge was observed among CHWs, when considering epilepsy according to the local names as treatable ("Dzumba") and other forms as untreatable ("Nzwiti"). CONCLUSION CHWs knowledge of medical treatment and epilepsy safety/risks were adequate. However, information on the causes of epilepsy, stigmatizing attitudes, cultural treatment, and some knowledge of epileptic seizure management were low. These areas of poor knowledge should be the focus of educating CHWs in increasing their ability to provide quality care for patients with epilepsy in Mozambique.
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Affiliation(s)
- Vasco Francisco Japissane Cumbe
- Mental Health Department, Ministry of Health, Provincial Health Directorate of Sofala, Beira 543, Mozambique
- Mental Health and Psychiatry Department, Faculty of Medicine, Eduardo Mondlane University (UEM), Maputo 257, Mozambique
- Medicine Department, Psychiatry and Mental Health Service, Beira Central Hospital, Sofala 1613, Mozambique
- Departamento de Psiquiatria, Escola Paulista de Medicina, Universidade Federal de São Paulo, UNIFESP, São Paulo 04017-030, Brazil
| | - Claire Greene
- Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY 10032, USA
| | - Afonso Mazine Tiago Fumo
- Medicine Department, Psychiatry and Mental Health Service, Beira Central Hospital, Sofala 1613, Mozambique
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo (USP), São Paulo 05403-903, Brazil
| | - Hélder Fumo
- Mental Health Department, Ministry of Health, Provincial Health Directorate of Sofala, Beira 543, Mozambique
| | - Dirceu Mabunda
- Mental Health and Psychiatry Department, Faculty of Medicine, Eduardo Mondlane University (UEM), Maputo 257, Mozambique
- Departamento de Psiquiatria, Escola Paulista de Medicina, Universidade Federal de São Paulo, UNIFESP, São Paulo 04017-030, Brazil
- Service of Psychiatry and Mental Health, Mavalane General Hospital, Maputo 7981000, Mozambique
| | - Lídia Chaúque Gouveia
- Mental Health and Psychiatry Department, Faculty of Medicine, Eduardo Mondlane University (UEM), Maputo 257, Mozambique
- Departamento de Psiquiatria, Escola Paulista de Medicina, Universidade Federal de São Paulo, UNIFESP, São Paulo 04017-030, Brazil
- Department of Mental Health, Directorate of Public Health, Ministry of Health, Maputo 264, Mozambique
| | - Maria A. Oquendo
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Cristiane S. Duarte
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Mohsin Sidat
- Department of Community Health, Faculty of Medicine, Eduardo Mondlane University (UEM), Maputo 257, Mozambique
| | - Jair de Jesus Mari
- Departamento de Psiquiatria, Escola Paulista de Medicina, Universidade Federal de São Paulo, UNIFESP, São Paulo 04017-030, Brazil
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Ziebold C, Silva-Ribeiro W, King D, McDaid D, Hoffmann MS, Romeo R, Pan PM, Miguel EC, Bressan RA, Rohde LA, Salum GA, Mari JDJ, Evans-Lacko S. Utilisation and costs of mental health-related service use among adolescents. PLoS One 2022; 17:e0273628. [PMID: 36084089 PMCID: PMC9462733 DOI: 10.1371/journal.pone.0273628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 08/11/2022] [Indexed: 11/18/2022] Open
Abstract
Background The high level of care needs for adolescents with mental health conditions represents a challenge to the public sector, especially in low and middle-income countries. We estimated the costs to the public purse of health, education, criminal justice and social care service use associated with psychiatric conditions among adolescents in Brazil; and examined whether the trajectory of psychopathology and its impact on daily life, and parental stigma towards mental illness, was associated with service utilisation and costs. Methods Data on reported service use among adolescents from a prospective community cohort (n = 1,400) were combined with Brazilian unit costs. Logistic regression and generalised linear models were used to examine factors associated with service use and associated costs, respectively. Results Twenty-two percent of those who presented with a psychiatric disorder used some type of service for their mental health in the previous twelve months. Higher odds of service use were associated with having a diagnosed mental disorder (either incident, [OR = 2.49, 95%CI = 1.44–4.30, p = 0.001], remittent [OR = 2.16, 95%CI = 1.27–3.69, p = 0.005] or persistent [OR = 3.01, 95%CI = 1.69–5.36, p<0.001]), higher impact of symptoms on adolescent’s life (OR = 1.32, 95%CI = 1.19–1.47, p<0.001) and lower parental stigma toward mental illness (OR = 1.12, 95%CI = 1.05–1.20, p = 0.001). Average annual cost of service use was 527.14 USD (s.d. = 908.10). Higher cost was associated with higher disorder impact (β = 0.25, 95%CI = 0.12–0.39, p<0.001), lower parental stigma (β = 0.12, 95%CI = 0.02–0.23, p = 0.020) and white ethnicity (β = 0.55, 95%CI = 0.04–1.07, p = 0.036). Conclusion The impact of mental health problems on adolescents’ daily lives and parental stigmatising attitudes toward mental illness were the main predictors of both service use and costs.
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Affiliation(s)
- Carolina Ziebold
- Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Wagner Silva-Ribeiro
- Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, Brazil
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, United Kingdom
| | - Derek King
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, United Kingdom
| | - David McDaid
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, United Kingdom
| | - Mauricio Scopel Hoffmann
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, United Kingdom
- Universidade Federal de Santa Maria, Santa Maria, Brazil
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil
| | - Renee Romeo
- King’s College London, London, United Kingdom
| | - Pedro Mario Pan
- Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, Brazil
- National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil
| | - Eurípedes Constantino Miguel
- National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil
- Universidade de São Paulo, São Paulo, Brazil
| | - Rodrigo Affonseca Bressan
- Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, Brazil
- National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil
| | - Luis Augusto Rohde
- National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil
- ADHD Outpatient Program & Developmental Psychiatry Program, Hospital de Clínicas de Porto Alegre, Brazil
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Giovanni Abrahão Salum
- National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Jair de Jesus Mari
- Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, Brazil
- National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil
| | - Sara Evans-Lacko
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, United Kingdom
- * E-mail:
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Ziebold C, Evans-Lacko S, Andrade MCR, Hoffmann MS, Fonseca L, Barbosa MG, Pan PM, Miguel E, Bressan RA, Rohde LA, Salum GA, de Jesus Mari J, Gadelha A. Childhood individual and family modifiable risk factors for criminal conviction: a 7-year cohort study from Brazil. Sci Rep 2022; 12:13381. [PMID: 35927553 PMCID: PMC9352677 DOI: 10.1038/s41598-022-13975-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 05/31/2022] [Indexed: 12/02/2022] Open
Abstract
Crime is a major public problem in low- and middle-income countries (LMICs) and its preventive measures could have great social impact. The extent to which multiple modifiable risk factors among children and families influence juvenile criminal conviction in an LMIC remains unexplored; however, it is necessary to identify prevention targets. This study examined the association between 22 modifiable individual and family exposures assessed in childhood (5-14 years, n = 2511) and criminal conviction at a 7-year follow-up (13-21 years, n = 1905, 76% retention rate) in a cohort of young people in Brazil. Population attributable risk fraction (PARF) was computed for significant risk factors. Criminal convictions were reported for 81 (4.3%) youths. Although most children living in poverty did not present criminal conviction (89%), poverty at baseline was the only modifiable risk factor significantly associated with crime (OR 4.14, 99.8% CI 1.38-12.46) with a PARF of 22.5% (95% CI 5.9-36.1%). It suggests that preventing children's exposure to poverty would reduce nearly a quarter of subsequent criminal convictions. These findings highlight the importance of poverty in criminal conviction, as it includes several deprivations and suggest that poverty eradication interventions during childhood may be crucial for reducing crime among Brazilian youth.
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Affiliation(s)
- Carolina Ziebold
- Departamento de Psiquiatria, Universidade Federal de São Paulo, Rua Major Maragliano, 241-Vila Mariana, São Paulo, 04017-030, Brazil.
| | - Sara Evans-Lacko
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, WC2A 2AE, UK
| | | | - Maurício Scopel Hoffmann
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, WC2A 2AE, UK
- Universidade Federal de Santa Maria, Santa Maria, Rio Grande do Sul, 97105-900, Brazil
- Department of Psychiatry, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Rio Grande do Sul, 90035-003, Brazil
| | - Lais Fonseca
- Departamento de Psiquiatria, Universidade Federal de São Paulo, Rua Major Maragliano, 241-Vila Mariana, São Paulo, 04017-030, Brazil
| | - Matheus Ghossain Barbosa
- Departamento de Psiquiatria, Universidade Federal de São Paulo, Rua Major Maragliano, 241-Vila Mariana, São Paulo, 04017-030, Brazil
| | - Pedro Mario Pan
- Departamento de Psiquiatria, Universidade Federal de São Paulo, Rua Major Maragliano, 241-Vila Mariana, São Paulo, 04017-030, Brazil
- National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, 05403-010, Brazil
| | - Euripedes Miguel
- National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, 05403-010, Brazil
- Department of Psychiatry, Universidade de São Paulo, São Paulo, 05403-903, Brazil
| | - Rodrigo Affonseca Bressan
- Departamento de Psiquiatria, Universidade Federal de São Paulo, Rua Major Maragliano, 241-Vila Mariana, São Paulo, 04017-030, Brazil
- National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, 05403-010, Brazil
| | - Luis Augusto Rohde
- Department of Psychiatry, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Rio Grande do Sul, 90035-003, Brazil
- National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, 05403-010, Brazil
- ADHD Outpatient and Developmental Psychiatry Programs, Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, 90035-903, Brazil
| | - Giovanni Abrahão Salum
- Department of Psychiatry, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Rio Grande do Sul, 90035-003, Brazil
- National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, 05403-010, Brazil
| | - Jair de Jesus Mari
- Departamento de Psiquiatria, Universidade Federal de São Paulo, Rua Major Maragliano, 241-Vila Mariana, São Paulo, 04017-030, Brazil
- National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, 05403-010, Brazil
| | - Ary Gadelha
- Departamento de Psiquiatria, Universidade Federal de São Paulo, Rua Major Maragliano, 241-Vila Mariana, São Paulo, 04017-030, Brazil
- National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, 05403-010, Brazil
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Cumbe VFJ, Manaca MN, Atkins DL, Muanido A, Hicks L, Oquendo MA, de Jesus Mari J, Wagenaar BH. Prevalence and correlates of suicidal behavior in primary care settings in Mozambique. BMC Psychiatry 2022; 22:423. [PMID: 35739519 PMCID: PMC9218046 DOI: 10.1186/s12888-022-04059-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 06/13/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND This study assessed the prevalence of suicidal behavior and associated risk factors in public primary health care in Mozambique. METHODS The Mini International Neuropsychiatric Interview was used to evaluate suicidal behavior among 502 adults attending three Primary Health Care (PHC) settings. RESULTS In the past month, 13% (n = 63) of PHC attendees expressed suicidal ideation, 8% (n = 40) had made a suicide plan, 4% (n = 20) had made a suicide attempt, and 5% (n = 25) reported a lifetime suicide attempt. Females had 2.8-fold increased odds of suicide plan (95% CI: 1.5, 5.5) and 3.3-fold increased odds of suicide attempt in the past month (95% CI: 1.2, 9.1). Each 10-year increase in age was associated with 0.61-fold the odds of suicide plan (95% CI: 0.38, 0.98) and 0.09-fold the odds of suicide attempt (95% CI: 0.01, 0.69) in the past month. People living with HIV (PLWHA) had 2.2-fold increased adjusted odds of past month suicide attempt (CI: 1.1, 4.1). CONCLUSION Suicidal behaviors are common among adults attending PHC clinics in Mozambique. Screening and linkage to effective preventive interventions are urgently needed in PHC settings. Females, younger individuals, and PLWHA are at elevated risk for suicidal behavior in PHC.
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Affiliation(s)
- Vasco F. J. Cumbe
- grid.415752.00000 0004 0457 1249Mental Health Department, Ministry of Health, Provincial Health Directorate of Sofala, Beira, Mozambique ,grid.8295.60000 0001 0943 5818Mental Health and Psychiatry Department, Faculty of Medicine, Eduardo Mondlane University (UEM), Maputo, Mozambique ,Medicine Department, Psychiatry and Mental Health Service, Beira Central Hospital, Sofala, Beira, Mozambique ,grid.411249.b0000 0001 0514 7202Departamento de Psiquiatria, Escola Paulista de Medicina, Universidade Federal de São Paulo, UNIFESP, São Paulo, Brazil
| | | | - Dana L. Atkins
- grid.34477.330000000122986657Department of Global Health, University of Washington, Seattle, WA USA
| | | | | | - Maria A. Oquendo
- grid.25879.310000 0004 1936 8972Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Jair de Jesus Mari
- grid.411249.b0000 0001 0514 7202Departamento de Psiquiatria, Escola Paulista de Medicina, Universidade Federal de São Paulo, UNIFESP, São Paulo, Brazil
| | - Bradley H. Wagenaar
- grid.34477.330000000122986657Department of Global Health, University of Washington, Seattle, WA USA ,grid.429096.0Health Alliance International, Seattle, WA USA ,grid.34477.330000000122986657Department of Epidemiology, University of Washington, Seattle, WA USA
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Mabunda D, Oliveira D, Sidat M, Cournos F, Wainberg M, Mari JDJ. Perceptions of Community Health Workers (CHW) on barriers and enablers to care for people with psychosis in rural Mozambique: findings of a focus group discussion study using the Capability, Opportunity, Motivation and Behaviour framework (COM-B framework). Hum Resour Health 2022; 20:44. [PMID: 35590423 PMCID: PMC9118750 DOI: 10.1186/s12960-022-00741-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/11/2022] [Indexed: 05/27/2023]
Abstract
BACKGROUND Psychotic disorders contribute significantly to the global disease burden by causing disability, impaired quality of life, and higher mortality in affected people compared with the general population. In rural settings, where there is limited or no access to healthcare, individuals living with psychotic disorders often seek support from Community Health Workers (CHWs). However, little is known about what CHWs know about psychosis and how they manage such cases. This study aimed to explore the CHWs perception of psychosis and their experiences and beliefs about the factors that might enable or hinder care-taking for patients with psychosis in rural settings in Mozambique. METHODS A qualitative study was conducted in rural districts of Maputo Province, a southern region of Mozambique, using six focus group discussions with participation of 79 CHWs. Thematic analysis was used informed by the Capabilities, Opportunities, Motivation and Behaviour framework (COM-B). RESULTS Nine primary themes were identified. Overall, CHWs perceived psychosis as treatable medical conditions and held a positive attitude about being part of the care-taking process of patients with psychosis in rural settings. Partnerships with key-stakeholders such as traditional healers, health care workers, and families, were perceived by CHWs as enablers to improve access to care in rural areas. However, stigma, myths, and lack of competencies to treat people with psychosis were perceived by CHWs as barriers for appropriate care. CONCLUSION CHWs, with adequate support, could play an important role in the care of patients with psychosis in rural settings, including identifying patients requiring care and referring them to appropriate healthcare professionals, and following up medicated patients with psychosis. Training of CHWs should consider inclusion of basic mental health care competencies.
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Affiliation(s)
- Dirceu Mabunda
- Department of Psychiatry and Psychological Medicine, Universidade Federal de São Paulo, São Paulo, Brazil.
- Department of Community Health, Faculty of Medicine, Eduardo Mondlane University, Avenue Salvador Allende nr. 702, P.O Box: 1106, Maputo, Mozambique.
| | - Déborah Oliveira
- Division of Social Protection and Health, InterAmerican Development Bank, Washington, DC, United States of America
| | - Mohsin Sidat
- Department of Community Health, Faculty of Medicine, Eduardo Mondlane University, Avenue Salvador Allende nr. 702, P.O Box: 1106, Maputo, Mozambique
| | - Francine Cournos
- Department of Psychiatry, Columbia University College of Physician and Surgeons, New York, NY, United States of America
| | - Milton Wainberg
- Department of Psychiatry, Columbia University College of Physician and Surgeons, New York, NY, United States of America
| | - Jair de Jesus Mari
- Department of Psychiatry and Psychological Medicine, Universidade Federal de São Paulo, São Paulo, Brazil
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Haddad M, Vistorte AOR, Haddad GG, Ribeiro W, Ziebold C, Asevedo E, Evans-Lacko S, Ulloa O, Mari JDJ. Management of common mental disorders should take place in primary health or specialized care? Clinical decisions of psychiatrists from Latin American countries. PLoS One 2022; 17:e0265308. [PMID: 35381017 PMCID: PMC8982860 DOI: 10.1371/journal.pone.0265308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 02/28/2022] [Indexed: 11/19/2022] Open
Abstract
Objective
The objective of our study was to explore clinical decisions of psychiatrists regarding the management of common mental disorders in primary care (PC) in four Latin Americans countries, through the application of clinical vignettes.
Methods
Using a cross-sectional design, we conducted a self-administered online questionnaire survey of psychiatrists from Bolivia, Brazil, Cuba, and Chile. The questionnaire covered sociodemographic and professional information. The psychiatrists’ clinical decisions were assessed through three clinical vignettes representing typical PC cases of depression, anxiety, and somatization.
Results
230 psychiatrists completed the online survey. Psychiatrists from Brazil were less likely to recognize depression as a mental disorder than those from Cuba (odds ratio (OR) = 0.30, 95% confidence interval (CI), 0.10 to 0.91, p < 0.04). Female gender (OR = 0.19, 95% CI, 0.04 to 0.91, p < 0.02) and older age (OR = 0.92, 95% CI, 0.87 to 0.97, p < 0.01) reduced the likelihood of agreement that depression cases should be treated by a Primary Care Physician (PCP). In the somatoform symptoms vignette, longer training duration increased the likelihood of agreement that treatment should be done by a psychiatrist instead of a PCP (OR = 1.19, 95% CI, 1.04 to 1.37, p < 0.01). In the anxiety vignette, females (OR = 2.38, 95% CI, 1.10 to 5.13, p < 0.01) and participants from Bolivia (compared with Cubans, OR = 4.19, 95% CI, 1.22 to 14.42, p < 0.02) were more likely to consider that these patients should be treated by a psychiatrist instead of a PCP.
Discussion
Most psychiatrist respondents agreed that patients with depression should be treated by PCPs and that somatoform and anxiety cases should be treated by psychiatrists. These results show that psychiatrists consider that they, and not PCPs, should treat patients with common mental disorders, regardless of the evidence showing that common mental disorders can be treated by primary care physicians in PC.
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Affiliation(s)
- Michel Haddad
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
- * E-mail:
| | | | | | - Wagner Ribeiro
- London School of Economics and Political Science – Care Policy and Evaluation Centre, London, United Kingdom
| | - Carolina Ziebold
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Elson Asevedo
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
- Global Mental Health Program, Columbia University, New York, New York, United States of America
| | - Sara Evans-Lacko
- London School of Economics and Political Science – Care Policy and Evaluation Centre, London, United Kingdom
- King’s College London, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
| | | | - Jair de Jesus Mari
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
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Mabunda D, Oliveira D, Sidat M, Cavalcanti MT, Cumbe V, Mandlate F, Wainberg M, Cournos F, de Jesus Mari J. Cultural adaptation of psychological interventions for people with mental disorders delivered by lay health workers in Africa: scoping review and expert consultation. Int J Ment Health Syst 2022; 16:14. [PMID: 35168650 PMCID: PMC8845308 DOI: 10.1186/s13033-022-00526-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 02/01/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Lay Health Workers (LHW) are important providers of community mental health services and help mitigate access and treatment gaps in Africa. However, there is a paucity of knowledge about the role and performance of these workers, as well as about the extent to which the interventions delivered are culturally adapted to the African context. AIMS This scoping review aimed to explore the content and aspects concerning the cultural adaptation and sustainability of psychological interventions delivered by LHW to people with mental disorders in Africa. METHODS We conducted a scoping review of the peer-reviewed literature published from January 2000 to December 2018 to identify psychological interventions delivered by LHW for people with mental disorders in Africa. We systematically searched PubMed, Google scholar and Hinari to select relevant publications. The articles were evaluated for risk of bias according to study design with the National Heart, Lung, and Blood Institute's (NHLBI) Quality Assessment Tools. Expert consultation was performed according to Arksey & O'Malley framework and cultural adaptation analysis was performed according to Bernal framework. RESULTS Out of 14,549 retrieved records, we identified ten peer-reviewed articles conducted in Zimbabwe, Uganda, South Africa and Zambia describing four distinct interventions. Six were randomized controlled trials; none addressed implementation outcomes. Group-based interpersonal therapy (n = 5), trauma-focused cognitive behaviour therapy (n = 1), problem solving therapy (n = 3) and narrative exposure therapy (n = 1) emerged as psychological interventions delivered by LHW for people with depression, anxiety, trauma and suicidal behavior. Psychological interventions delivered by LHW in Africa were all culturally adapted to meet the competence of LHW. All the interventions were associated with symptom improvement, but the quality of this evidence varied widely with study design. CONCLUSION Task-shifting psychological interventions delivered by LHW after appropriate cultural adaptation show promise for addressing unmet mental health care needs in Africa. More effectiveness and implementation evidence is needed, especially with regard to psychological interventions delivered by LHW for adolescence, older people and those with severe mental disorders and suicidal behaviors.
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Affiliation(s)
- Dirceu Mabunda
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil.
- Department of Community Health, Faculty of Medicine, Eduardo Mondlane University, Avenue Salvador Allende nr. 702, P.O Box: 1106, Maputo, Mozambique.
| | - Déborah Oliveira
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Mohsin Sidat
- Department of Community Health, Faculty of Medicine, Eduardo Mondlane University, Avenue Salvador Allende nr. 702, P.O Box: 1106, Maputo, Mozambique
| | | | - Vasco Cumbe
- Department of Community Health, Faculty of Medicine, Eduardo Mondlane University, Avenue Salvador Allende nr. 702, P.O Box: 1106, Maputo, Mozambique
| | - Flávio Mandlate
- Department of Community Health, Faculty of Medicine, Eduardo Mondlane University, Avenue Salvador Allende nr. 702, P.O Box: 1106, Maputo, Mozambique
| | - Milton Wainberg
- Department of Psychiatry, Columbia University College of Physician and Surgeons, New York, USA
| | - Francine Cournos
- Department of Psychiatry, Columbia University College of Physician and Surgeons, New York, USA
| | - Jair de Jesus Mari
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
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Vistorte AOR, Ribeiro W, Ziebold C, Asevedo E, Evans-Lacko S, Varas DJ, Gutierrez N, Haddad M, Ulloa O, Martínez R, Harada AS, Mari JDJ. Adaptation to Brazilian Portuguese and Latin-American Spanish and psychometric properties of the Mental Illness Clinicians' Attitudes Scale (MICA v4). Trends Psychiatry Psychother 2021; 45:e20210291. [PMID: 34854658 PMCID: PMC10164403 DOI: 10.47626/2237-6089-2021-0291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/13/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe translation to Spanish and Portuguese and adaptation of the Mental Illness Clinicians' Attitudes Scale version 4 (MICA v4). METHODS The questionnaire was administered to primary care physicians (PCPs) from four Latin-American countries, Brazil, Bolivia, Chile, and Cuba. The validation process included four phases: 1) translation of the questionnaire to Spanish and Portuguese; 2) assessment of face validity; 3) assessment of reliability; and 4) evaluation of construct validity with confirmatory factor analysis (CFA). RESULTS The study sample comprised 427 PCPs. The mean age of the Spanish-speaking sample (n = 252) was 40.1 (S.D = 9.7) years and the mean age of the Portuguese-speaking sample (n = 150) was 40.2 (S.D = 10.9) years. Both models demonstrated "appropriate" internal reliability. Total omega was 0.91 for the Spanish-speaking sample and 0.89 for the Portuguese-speaking sample. The CFA of both questionnaires showed an appropriate fit for a three-factor model (Portuguese: CFI = 0.927; TLI = 0.913; RMSEA = 0.066; Spanish: CFI = 0.945; TLI = 0.935; RMSEA = 0.068). CONCLUSION The Latin-American versions of the MICA v4 in Spanish and Brazilian Portuguese have appropriate psychometric properties, good internal consistency, and are applicable to and acceptable in the Latin-American context. The instrument proved its validity for collecting data on stigmatizing attitudes among health professionals in different contexts and cultures.
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Affiliation(s)
- Angel O. Rojas Vistorte
- Departamento de PsiquiatriaUniversidade Federal de São PauloSão PauloSPBrazil Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
| | - Wagner Ribeiro
- Departamento de PsiquiatriaUniversidade Federal de São PauloSão PauloSPBrazil Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
- London School of Economics and Political ScienceLondonUnited Kingdom Personal Social Services Research Unit, London School of Economics and Political Science, London, United Kingdom.
| | - Carolina Ziebold
- Departamento de PsiquiatriaUniversidade Federal de São PauloSão PauloSPBrazil Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
| | - Elson Asevedo
- Departamento de PsiquiatriaUniversidade Federal de São PauloSão PauloSPBrazil Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
- Global Mental Health ProgramColumbia UniversityNew YorkNYUSA Global Mental Health Program, Columbia University, New York, NY, USA.
| | - Sara Evans-Lacko
- London School of Economics and Political ScienceLondonUnited Kingdom Personal Social Services Research Unit, London School of Economics and Political Science, London, United Kingdom.
- Universidad Internacional de La RiojaLogronoLa RiojaSpain Universidad Internacional de La Rioja, Logrono, La Rioja, Spain.
| | - Denisse Jaen Varas
- Departamento de PsiquiatriaUniversidade Federal de São PauloSão PauloSPBrazil Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
| | - Nataly Gutierrez
- Departamento de PsiquiatriaUniversidade Federal de São PauloSão PauloSPBrazil Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
| | - Michel Haddad
- Departamento de PsiquiatriaUniversidade Federal de São PauloSão PauloSPBrazil Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
| | - Oscar Ulloa
- Universidad Internacional de La RiojaLogronoLa RiojaSpain Universidad Internacional de La Rioja, Logrono, La Rioja, Spain.
| | - Ricel Martínez
- Universidad Internacional de La RiojaLogronoLa RiojaSpain Universidad Internacional de La Rioja, Logrono, La Rioja, Spain.
| | - Andresa Sartor Harada
- Universidad Internacional de La RiojaLogronoLa RiojaSpain Universidad Internacional de La Rioja, Logrono, La Rioja, Spain.
| | - Jair de Jesus Mari
- Departamento de PsiquiatriaUniversidade Federal de São PauloSão PauloSPBrazil Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
- Institute of Psychiatry, Psychology & NeuroscienceHealth Service and Population Research DepartmentKing’s College LondonLondonUnited Kingdom Institute of Psychiatry, Psychology & Neuroscience, Health Service and Population Research Department, King’s College London, London, United Kingdom.
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Kogan CS, Maj M, Rebello TJ, Keeley JW, Kulygina M, Matsumoto C, Robles R, Huang J, Zhong N, Chakrabarti S, Figueira ML, Stein DJ, Strakowski SM, Garcia-Pacheco JA, Burns S, Montoya M, Andrade L, Ayuso-Mateos JL, Arango I, Balhara YPS, Bryant R, Cournos F, Porto JAD, Meyer TD, Medina-Mora ME, Gureje O, First MB, Gaebel W, Khoury B, Krasnov VN, de Jesus Mari J, Maruta T, Pike KM, Roberts MC, Sharan P, Zhao M, Reed GM. A global field study of the international classification of diseases (ICD-11) mood disorders clinical descriptions and diagnostic guidelines. J Affect Disord 2021; 295:1138-1150. [PMID: 34706426 DOI: 10.1016/j.jad.2021.08.050] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/18/2021] [Accepted: 08/21/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND We report results of an internet-based field study evaluating the diagnostic guidelines for ICD-11 mood disorders. Accuracy of clinicians' diagnostic judgments applying draft ICD-11 as compared to the ICD-10 guidelines to standardized case vignettes was assessed as well as perceived clinical utility. METHODS 1357 clinician members of the World Health Organization's Global Clinical Practice Network completed the study in English, Spanish, Japanese or Russian. Participants were randomly assigned to apply ICD-11 or ICD-10 guidelines to one of eleven pairs of case vignettes. RESULTS Clinicians using the ICD-11 and ICD-10 guidelines achieved similar levels of accuracy in diagnosing mood disorders depicted in vignettes. Those using the ICD-11 were more accurate in identifying depressive episode in recurrent depressive disorder. There were no statistically significant differences detected across classifications in the accuracy of identifying dysthymic or cyclothymic disorder. Circumscribed problems with the proposed ICD-11 guidelines were identified including difficulties differentiating bipolar type I from bipolar type II disorder and applying revised severity ratings to depressive episodes. Clinical utility of ICD-11 bipolar disorders was found to be significantly lower than for ICD-10 equivalent categories. LIMITATIONS Standardized case vignettes were manipulated to evaluate specific changes. The degree of accuracy of clinicians' diagnostic judgments may not reflect clinical decision-making with patients. CONCLUSIONS Alignment of the ICD-11 with current research appears to have been achieved without sacrificing diagnostic accuracy or clinical utility though specific training may be necessary as ICD-11 is implemented worldwide. Areas in which the ICD-11 guidelines did not perform as intended resulted in further revisions.
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Affiliation(s)
- Cary S Kogan
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier Pvt., Vanier Building, Ottawa, Ontario K1N 6N5, Canada.
| | - Mario Maj
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Tahilia J Rebello
- Global Mental Health Program, Columbia University and New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Jared W Keeley
- Department of Psychology, Virginia Commonwealth University, 800 W. Franklin Street, P.O. Box 842018, Richmond, VA, 23284-2018, USA
| | - Maya Kulygina
- Moscow Research Institute of Psychiatry, Poteshnaya 3, 107076, Moscow, Russian Federation
| | - Chihiro Matsumoto
- National Study Coordinator for ICD-11 Field Studies, ICD-11 Committee, Japanese Society of Psychiatry and Neurology, Hongo-Yumicho Building, 2-38-4, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Rebeca Robles
- Instituto Nacional de Psiquiatría 'Ramón de la Fuente', WHO Collaborating Centre on Addictions and Mental Health, Calzada Mexico-Xochimilco 101, Tlalpan, ZC 14370, Ciudad de México, Mexico
| | - Jingjing Huang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, WHO Collaborating Centre for Research and Training in Mental Health, 600 Wan Ping Nan Rd., Shanghai, 200030, People's Republic of China
| | - Na Zhong
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, WHO Collaborating Centre for Research and Training in Mental Health, 600 Wan Ping Nan Rd., Shanghai, 200030, People's Republic of China
| | - Subho Chakrabarti
- Dept. Of Psychiatry, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, - 160012, India
| | - Maria Luisa Figueira
- Department of Psychiatry, Faculty of Medicine, University of Lisbon, 1699, Lisboa Codex, Portugal
| | - Dan J Stein
- Department of Psychiatry, University of Cape Town and Groote Schuur Hospital, J-Block, Anzio Road, Observatory 7925, South Africa
| | - Stephen M Strakowski
- Dell Medical School, University of Texas at Austin, Health Learning Building, 1501 Red River St., Austin, Texas, 78712, USA
| | - José A Garcia-Pacheco
- Centro de Investigación y Docencia Económica, Carr. México-Toluca 3655, Santa Fe, Altavista, Álvaro Obregón, 01210, Ciudad de México, México
| | - Samantha Burns
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier Pvt., Vanier Building, Ottawa, Ontario K1N 6N5, Canada
| | - Madeline Montoya
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier Pvt., Vanier Building, Ottawa, Ontario K1N 6N5, Canada
| | - Laura Andrade
- Institute of Psychiatry, School of Medicine, University of São Paulo, Av. Dr. Arnaldo, 455 - Cerqueira César, São Paulo, 01246903, Brazil
| | - José L Ayuso-Mateos
- Department of Psychiatry, Universidad Autonoma de Madrid; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM); Instituto de Investigación Sanitaria La Princesa, Madrid, Spain
| | - Ivan Arango
- Instituto Nacional de Psiquiatría 'Ramón de la Fuente', WHO Collaborating Centre on Addictions and Mental Health, Calzada Mexico-Xochimilco 101, Tlalpan, ZC 14370, Ciudad de México, Mexico
| | - Yatan Pal Singh Balhara
- National Drug Dependence Treatment Center and Department of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | | | - Francine Cournos
- Departments of Epidemiology and Psychiatry, Columbia University Medical Center, 722 West 168th St, 10032, New York, NY
| | - José Alberto Del Porto
- Department of Psychiatry, Universidade Federal de São Paulo, Rua Borges Lagoa 570 - 1° andar, Vila Clementino- São Paulo-SP, 04038-000, Brazil
| | - Thomas D Meyer
- Faillace Department of Psychiatry & Behavioral Sciences, McGovern Medical School, University of Texas HSC at Houston, 1941 East Road, Houston, Texas, 77054, USA
| | - Maria-Elena Medina-Mora
- The Health Management Center, Seitoku University, 550 Iwase, Matsudo City, Chiba Prefecture, 271-8555, Japan
| | - Oye Gureje
- Department of Psychiatry, University of Ibadan, WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Drug and Alcohol Abuse, University College Hospital, PMB, 5116 Ibadan, Nigeria
| | - Michael B First
- Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, 722 West 168th St, 10032, New York, NY
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, WHO Collaborating Centre for Quality Assurance and Empowerment in Mental Health, Bergische Landstr. 2, 40629, Düsseldorf, Germany
| | - Brigitte Khoury
- Department of Psychiatry, American University of Beirut Medical Center, P.O. Box 11-0236 - Riad El Solh 1107 2020 Beirut, Lebanon
| | - Valery N Krasnov
- Moscow Research Institute of Psychiatry, Poteshnaya 3, 107076, Moscow, Russian Federation
| | - Jair de Jesus Mari
- Department of Psychiatry, Universidade Federal de São Paulo, Rua Borges Lagoa 570 - 1° andar, Vila Clementino- São Paulo-SP, 04038-000, Brazil
| | - Toshimasa Maruta
- The Health Management Center, Seitoku University, 550 Iwase, Matsudo City, Chiba Prefecture, 271-8555, Japan
| | - Kathleen M Pike
- Global Mental Health Program, Columbia University and New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Michael C Roberts
- University of Kansas, Clinical Child Psychology Program, Dole Human Development Center, Lawrence, KS, 66045, USA
| | - Pratap Sharan
- Department of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Min Zhao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, WHO Collaborating Centre for Research and Training in Mental Health, 600 Wan Ping Nan Rd., Shanghai, 200030, People's Republic of China
| | - Geoffrey M Reed
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA, and Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
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17
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Ribeiro WS, Gronholm PC, Silvestre de Paula C, Hoffmann MS, Rojas Vistorte AO, Zugman C, Pan PM, de Jesus Mari J, Rohde LA, Miguel EC, Bressan RA, Salum GA, Evans-Lacko S. Development and validation of the Brazilian Portuguese Version of the Reported and Intended Behaviour Scale (RIBS-BP). Stigma and Health 2021. [DOI: 10.1037/sah0000224] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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18
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Wainberg ML, Gouveia ML, Stockton MA, Feliciano P, Suleman A, Mootz JJ, Mello M, Fiks Salem A, Greene MC, Bezuidenhout C, Ngwepe P, Lovero KL, Fortunato Dos Santos P, Schriger SH, Mandell DS, Mulumba R, Neves Anube A, Mabunda D, Mandlate F, Cournos F, Alves-Bradford JM, Nicholson T, Kann B, Fumo W, Duarte CS, de Jesus Mari J, Mello MF, Mocumbi AO, Oquendo MA, Weissman MM. Technology and implementation science to forge the future of evidence-based psychotherapies: the PRIDE scale-up study. Evid Based Ment Health 2021; 24:19-24. [PMID: 33177149 PMCID: PMC8025148 DOI: 10.1136/ebmental-2020-300199] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/13/2020] [Accepted: 10/21/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To report the interim results from the training of providers inevidence-based psychotherapies (EBPs) and use of mobile applications. DESIGN AND SETTING The Partnerships in Research to Implement and Disseminate Sustainable and Scalable Evidence (PRIDE) study is a cluster-randomised hybrid effectiveness-implementation trial comparing three delivery pathways for integrating comprehensive mental healthcare into primary care in Mozambique. Innovations include the use of EBPs and scaling-up of task-shifted mental health services using mobile applications. MAIN OUTCOME MEASURES We examined EBP training attendance, certification, knowledge and intentions to deliver each component. We collected qualitative data through rapid ethnography and focus groups. We tracked the use of the mobile applications to investigate early reach of a valid screening tool (Electronic Mental Wellness Tool) and the roll out of the EBPs PARTICIPANTS: Psychiatric technicians and primary care providers trained in the EBPs. RESULTS PRIDE has trained 110 EBP providers, supervisors and trainers and will train 279 community health workers in upcoming months. The trainings improved knowledge about the EBPs and trainees indicated strong intentions to deliver the EBP core components. Trained providers began using the mobile applications and appear to identify cases and provide appropriate treatment. CONCLUSIONS The future of EBPs requires implementation within existing systems of care with fidelity to their core evidence-based components. To sustainably address the vast mental health treatment gap globally, EBP implementation demands: expanding the mental health workforce by training existing human resources; sequential use of EBPs to comprehensively treat mental disorders and their comorbid presentations and leveraging digital screening and treatment applications.
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Affiliation(s)
- Milton L Wainberg
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
- New York State Psychiatric Institute, New York, New York, USA
| | - Maria Lídia Gouveia
- Mental Health Department, Ministry of Health of Mozambique, Maputo, Mozambique
| | - Melissa Ann Stockton
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Paulino Feliciano
- Mental Health Department, Ministry of Health of Mozambique, Nampula, Mozambique
| | - Antonio Suleman
- Mental Health Department, Ministry of Health of Mozambique, Nampula, Mozambique
| | - Jennifer J Mootz
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
- New York State Psychiatric Institute, New York, New York, USA
| | - Milena Mello
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
- New York State Psychiatric Institute, New York, New York, USA
| | - Andre Fiks Salem
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
- New York State Psychiatric Institute, New York, New York, USA
| | - M Claire Greene
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Charl Bezuidenhout
- Research Unit, Foundation for Professional Development, Pretoria, South Africa
| | - Phuti Ngwepe
- Research Unit, Foundation for Professional Development, Pretoria, South Africa
| | - Kathryn L Lovero
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | | | - Simone H Schriger
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | - Anibal Neves Anube
- Docente da Faculdade de Ciências de Saúde-UniLúrio, Hospital Psiquiátrico de Nampula, Nampula, Mozambique
| | | | - Flavio Mandlate
- Mental Health Department, Ministry of Health of Mozambique, Maputo, Mozambique
| | - Francine Cournos
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Jean-Marie Alves-Bradford
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
- New York State Psychiatric Institute, New York, New York, USA
| | - Terriann Nicholson
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
- New York State Psychiatric Institute, New York, New York, USA
| | - Bianca Kann
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
- New York State Psychiatric Institute, New York, New York, USA
| | - Wilza Fumo
- Mental Health Department, Ministry of Health of Mozambique, Maputo, Mozambique
| | - Cristiane S Duarte
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
- New York State Psychiatric Institute, New York, New York, USA
| | - Jair de Jesus Mari
- Department of Psychiatry and Medical Psychology, Escola Paulista de Medicina, Universidade Federal de São Paulo, Sao Paulo, São Paulo, Brazil
| | | | - Ana O Mocumbi
- Universidade Eduardo Mondlane, Maputo, Mozambique
- Doenças Não Transmissíveis, Instituto Nacional de Saúde, Maputo, Mozambique
| | - Maria A Oquendo
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Myrna M Weissman
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
- New York State Psychiatric Institute, New York, New York, USA
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19
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Affiliation(s)
- Carolina Ziebold
- Postgraduate Program in Developmental Disorders, Mackenzie Presbyterian University, São Paulo, Brazil
| | - Jair de Jesus Mari
- Department of Psychiatry & Medical Psychology, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
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20
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Mari JDJ, Oquendo MA. Mental health consequences of COVID-19: the next global pandemic. Trends Psychiatry Psychother 2020; 42:219-220. [PMID: 32844977 PMCID: PMC7879073 DOI: 10.1590/2237-6089-2020-0081] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 06/28/2020] [Indexed: 11/22/2022]
Affiliation(s)
- Jair de Jesus Mari
- Departamento de Psiquiatria , Escola Paulista de Medicina , Universidade Federal de São Paulo (UNIFESP), São Paulo , SP , Brazil .,Standing Committee on Science, Education and Publication , World Psychiatric Association , Geneva , Switzerland
| | - Maria A Oquendo
- Perelman School of Medicine , University of Pennsylvania , Philadelphia , PA , USA .,American College of Neuropsychopharmacology , Brentwood , TN , USA .,American Foundation for Suicide Prevention , New York , NY , USA
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21
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Del Sant LC, Sarin LM, Magalhães EJM, Lucchese AC, Tuena MA, Nakahira C, Fava VAR, Delfino R, Surjan J, Steiglich MS, Barbosa M, Abdo G, Cohrs FM, Liberatori A, Del Porto JA, Lacerda ALT, de Jesus Mari J. Effects of subcutaneous esketamine on blood pressure and heart rate in treatment-resistant depression. J Psychopharmacol 2020; 34:1155-1162. [PMID: 32638662 DOI: 10.1177/0269881120922955] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION AND OBJECTIVES The impact of multiple subcutaneous (s.c.) esketamine injections on the blood pressure (BP) and heart rate (HR) of patients with unipolar and bipolar treatment-resistant depression (TRD) is poorly understood. This study aimed to assess the cardiovascular safety of multiple s.c. doses of esketamine in patients with TRD. METHODS Seventy TRD patients received 394 weekly s.c. esketamine injections in conjunction with oral antidepressant therapy for up to six weeks. Weekly esketamine doses were 0.5, 0.75 or 1.0 mg/kg according to each patient's response to treatment. Participants were monitored before each treatment and every 15 minutes thereafter for 120 minutes. We assessed systolic blood pressure (SBP), diastolic blood pressure (DBP), and HR measurements for the entire treatment course. RESULTS BP increased after the first s.c. esketamine injection, reaching maximum mean SBP/DBP levels of 4.87/5.54 mmHg within 30-45 minutes. At the end of monitoring, 120 minutes post dose, vital signs returned to pretreatment levels. We did not detect significant differences in BP between doses of 0.5, 0.75, and 1 mg/kg esketamine. Mean HR did not differ significantly between doses or before and after s.c. esketamine injection. CONCLUSIONS The BP changes observed with repeated s.c. esketamine injections were mild and well tolerated for doses up to 1 mg/kg. The s.c. route is a simple and safe method of esketamine administration, even for patients with clinical comorbidities, including obesity, hypertension, diabetes, and dyslipidemia. However, 14/70 patients experienced treatment-emergent transient hypertension (SBP >180 mmHg and/or a DBP >110 mmHg). Therefore, we strongly recommend monitoring BP for 90 minutes after esketamine dosing. Since s.c. esketamine is cheap, requires less frequent dosing (once a week), and is a simpler procedure compared to intravenous infusions, it might have an impact on public health.
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Affiliation(s)
| | - Luciana Maria Sarin
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | | | | | - Marco Aurélio Tuena
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Carolina Nakahira
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | | | - Rodrigo Delfino
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil.,PRODAF-Programa de Transtornos Afetivos, Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Juliana Surjan
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil.,PRODAF-Programa de Transtornos Afetivos, Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Matheus Souza Steiglich
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil.,PRODAF-Programa de Transtornos Afetivos, Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Matheus Barbosa
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Guilherme Abdo
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | | | - Aroldo Liberatori
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - José Alberto Del Porto
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil.,PRODAF-Programa de Transtornos Afetivos, Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Acioly Luiz Tavares Lacerda
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil.,PRODAF-Programa de Transtornos Afetivos, Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil.,LiNC-Laboratory of Integrative Neuroscience, Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil.,Center for Interventional Psychiatry, Hospital Sao Marcos, Jaboticabal, Brazil
| | - Jair de Jesus Mari
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil.,LiNC-Laboratory of Integrative Neuroscience, Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
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22
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Cumbe VFJ, Muanido A, Manaca MN, Fumo H, Chiruca P, Hicks L, de Jesus Mari J, Wagenaar BH. Validity and item response theory properties of the Patient Health Questionnaire-9 for primary care depression screening in Mozambique (PHQ-9-MZ). BMC Psychiatry 2020; 20:382. [PMID: 32698788 PMCID: PMC7374823 DOI: 10.1186/s12888-020-02772-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 06/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Depression is one of the leading causes of disability in Mozambique; however, few patients with depression are identified in primary care. To our knowledge, there are no validated tools for depression screening in Mozambique. The aim of this study was to validate the Patient Health Questionnaire-9 (PHQ-9) for use in primary care settings in Mozambique. METHODS The PHQ-9 was adapted using a structured multi-phase process led by a team of bilingual experts followed by a review by lay individuals and pilot-testing including cognitive interviews. The final Mozambican PHQ-9 (PHQ-9-MZ) was applied among 502 individuals randomly selected from antenatal, postpartum, and general outpatient consultations in three Ministry of Health primary healthcare clinics in Sofala Province, Mozambique. The PHQ-9-MZ was evaluated against the MINI 5.0-MZ as a gold standard diagnostic tool. RESULTS The majority of participants were female (74%), with a mean age of 28. Using the MINI 5.0-MZ, 43 (9%) of the sample tested positive for major depressive disorder. Items of the PHQ-9-MZ showed good discrimination and factor loadings. One latent factor of depression explained 54% of the variance in scores. Questions 3 (sleep) and 5 (appetite) had the lowest item discrimination and factor loadings. The PHQ-9-MZ showed good internal consistency, with a Cronbach's alpha of 0.84, and an area under the receiver operating characteristic curve (AUROC) of 0.81 (95% CI: 0.73, 0.89). The PHQ-2-MZ had an AUROC of 0.78 (95% CI: 0.70, 0.85). Using a cut-point of ≥9, the PHQ-9-MZ had a sensitivity of 46.5% and a specificity of 93.5%. Using a cut-point of ≥2, the PHQ-2-MZ had a sensitivity of 74.4% and a specificity of 71.7%. Increasing the cut-point to ≥3, the PHQ-2-MZ has a sensitivity of 32.6% and a specificity of 94.6%. CONCLUSIONS The PHQ-9-MZ and PHQ-2-MZ emerge as two valid alternatives for screening for depression in primary health care settings in Mozambique. Depending on program needs and weighing the value of minimizing false positives and false negatives, the PHQ-9-MZ can be employed with cut-points ranging from ≥8 to ≥11, and the PHQ-2-MZ with cut-points ranging from ≥2 to ≥3.
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Affiliation(s)
- Vasco F J Cumbe
- Department of Mental Health, Sofala Provincial Health Directorate, Ministry of Health, Rua Poder Popular n.° 11 - 50. Caixa Postal 583. 4° Andar, Beira, Sofala, Moçambique.
- Departamento de Psiquiatria, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
- Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Moçambique.
| | | | | | - Hélder Fumo
- Department of Mental Health, Sofala Provincial Health Directorate, Ministry of Health, Rua Poder Popular n.° 11 - 50. Caixa Postal 583. 4° Andar, Beira, Sofala, Moçambique
| | - Pedro Chiruca
- Department of Mental Health, Sofala Provincial Health Directorate, Ministry of Health, Rua Poder Popular n.° 11 - 50. Caixa Postal 583. 4° Andar, Beira, Sofala, Moçambique
| | | | - Jair de Jesus Mari
- Departamento de Psiquiatria, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Bradley H Wagenaar
- Health Alliance International, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
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Ramos LR, Mari JDJ, Fontanella AT, Pizzol TDSD, Bertoldi AD, Mengue SS. Nationwide use of psychotropic drugs for treatment of self-reported depression in the Brazilian urban adult population. Rev Bras Epidemiol 2020; 23:e200059. [PMID: 32578675 DOI: 10.1590/1980-549720200059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 01/07/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Antidepressant use is increasing worldwide, but national data on psychotropic drug use by depressed patients in Brazil is lacking. METHODOLOGY Between 2013 and 2014, a representative sample of urban adult individuals were asked if they had a diagnosis of chronic disease, had a medical indication for drug treatment, and were taking chronic medications at the time for each reported diagnosis. We analyzed the frequencies of reported depression and the medications related to this disease. RESULTS Overall, 6.1% of respondents reported depression. The prevalence increased with age - 9.5% among the elders - was higher among women (8.9%) and in the south of the country (8.9%). As a single disease, the prevalence of depression was higher among young people (17.6%). Among those with multimorbidity, the prevalence of depression rose to 25.7%. Of those who reported depression, 81.3% had medical indication for treatment and 90.3% were under treatment - this proportion was lower among young people (84.5%) and those living in the poorest region (78.6%). Antidepressants accounted for 47.2% of psychotropic drugs taken by respondents with depression, with regional differences - only 30% used antidepressants in the North. Polypharmacy was reported by 22% of those with depression and other chronic diseases. CONCLUSION Depression in Brazil, is common among young adults as a single chronic disease and highly prevalent among people with chronic multimorbidity, especially the young. The treatment gap was larger among young people and in the less developed regions of the country.
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Affiliation(s)
- Luiz Roberto Ramos
- Department of Preventive Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo - São Paulo (SP), Brazil
| | - Jair de Jesus Mari
- Department of Psychiatry, Escola Paulista de Medicina, Universidade Federal de São Paulo - São Paulo (SP), Brazil
| | - Andréia Turmina Fontanella
- Graduate Program in Epidemiology, School of Medicine, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brazil
| | - Tatiane da Silva Dal Pizzol
- Department of Drug Manufacturing and Control, School of Pharmacy, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brazil
| | - Andréa Dâmaso Bertoldi
- Department of Social Medicine, School of Medicine, Universidade Federal de Pelotas - Pelotas (RS), Brazil
| | - Sotero Serrate Mengue
- Graduate Program in Epidemiology, School of Medicine, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brazil
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Vilela TDR, Rocha MMD, Figlie NB, Pillon SC, Diehl A, Mari JDJ. Domestic violence and risk of internalizing and externalizing problems in adolescents living with relatives displaying substance use disorders. J bras psiquiatr 2020. [DOI: 10.1590/0047-2085000000268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
ABSTRACT Objective To investigate the association between exposure to domestic violence and increased risk of internalizing and externalizing problems and substance use among adolescents living with relatives with substance use disorder (SUD) at a low-income community of São Paulo, Brazil. Methods A cross-sectional study was conducted with 102 adolescents aged 12-17 years (M = 14.2, SD = 1.7) who were living with relatives suffering from SUD. Outcomes were measured using the Youth Self-Report (YSR), psychosocial stress factors questionnaire, Drug Use Screening Inventory (DUSI) and Phrase Inventory of Intrafamily Child Abuse (PIICA). Results The sample presented high prevalence of emotional/behavioral problems with YSR’s scores in the clinical range for Internalizing Problems (24.5%), Externalizing Problems (21.6%), and Total Problems (26.5%). The presence of mental health problems predicted substance use (PR = 2.22; 95% CI = 1.2-4.13), and substance use predicted increased risk of mental health problems. Alcohol use predicted more than double the risk of emotional/behavioral problems (PR = 2.01; 95% CI = 1.08-3.76), while illicit drug use was associated with an almost threefold increase in the prevalence of Internalizing (PR = 2.87; 95% CI = 1.19-6.89) and Externalizing Problems (PR = 3.3; 95% CI = 1.35-8.04). Conclusion Adolescents of relatives with SUD are at risk of developing emotional and behavioral problems. These findings reinforce the need to develop public mental health policies, which include protective interventions to adolescents living in families affected by substance use disorders.
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Longo MSDC, Vilete LMP, Figueira I, Quintana MI, Mello MF, Bressan RA, Mari JDJ, Ribeiro WS, Andreoli SB, Coutinho ESF. Comorbidity in post-traumatic stress disorder: A population-based study from the two largest cities in Brazil. J Affect Disord 2020; 263:715-721. [PMID: 31780134 DOI: 10.1016/j.jad.2019.11.051] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 05/07/2019] [Accepted: 11/10/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND This study investigated the patterns of comorbidity between PTSD and depression, other anxiety disorders, alcohol-related disorders using the DSM-IV and ICD-10 criteria. The temporal sequence of the comorbid diagnoses was also investigated. METHODS We used data from a large population-based survey carried out between 2007 and 2008 in the two largest cities in Brazil: São Paulo and Rio de Janeiro. RESULTS Diagnoses of depression, other anxiety disorders, and alcohol-related disorder were more prevalent in the people with PTSD than in those without PTSD. Using the DSM-IV criteria, approximately 67% of cases presenting PTSD were also diagnosed with another mental disorder. The diagnosis category of other anxiety disorders presented the highest proportion of comorbidity (53%). Depression was found in 34% person with PTSD whilst alcohol-related disorders were observed in 7%. Considering the temporal relationship, the onset of comorbid depression was uniformly distributed through the periods before, within the same year and after PTSD's onset. When other anxiety disorders were comorbid with PTSD, in almost 90% of the cases the other anxiety disorders preceded PTSD. For comorbidity between of alcohol-related disorders and PTSD, in 50% of the cases alcohol-related disorders preceded the diagnosis of PTSD. LIMITATIONS The cross-sectional design imposes limitations on establishing a temporal relationship between the onset of psychiatric disorders due to memory bias. CONCLUSIONS Our findings indicate that among individuals presenting comorbid PTSD and other anxiety disorders, this diagnosis tend to precede PTSD. Comorbid cases are more frequent and more severe, and this should be taken into account in therapeutic research and clinical practice.
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Affiliation(s)
| | | | - Ivan Figueira
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Maria Inês Quintana
- Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Marcelo Feijó Mello
- Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Rodrigo A Bressan
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience King's College London, UK
| | - Jair de Jesus Mari
- Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Wagner Silva Ribeiro
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
| | | | - Evandro Silva Freire Coutinho
- Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública, Rio de Janeiro, Brazil; Instituto de Medicina Social da Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
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Hoffmann MS, Pan PM, Manfro GG, de Jesus Mari J, Miguel EC, Bressan RA, Rohde LA, Salum GA. Independent and interactive associations of temperament dimensions with educational outcomes in young adolescents. Learning and Individual Differences 2020. [DOI: 10.1016/j.lindif.2019.101817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Del Sant L, Sarin LM, de Jesus Mari J. Short - Term Ketamine Administration in Treatment - Resistant Depression: Focus on Cardiovascular Safety. Psychiatr Danub 2020; 32:219-220. [PMID: 32796789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Lorena Del Sant
- Department of Psychiatry of Federal University of Săo Paulo, R. Maj. Maragliano, 241 - Vila Mariana, 04017-030, Săo Paulo - SP, Brazil,
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Abdalla-Filho E, de Jesus Mari J, Diehl A, Vieira DL, Ribeiro RB, Marins de Moraes T, Reed GM, Kismodi E, Cordeiro Q. Forensic Implications of the New Classification of ICD-11 Paraphilic Disorders in Brazil. J Sex Med 2019; 16:1814-1819. [PMID: 31551191 DOI: 10.1016/j.jsxm.2019.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 07/21/2019] [Accepted: 07/28/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION The World Health Organization (WHO) Department of Mental Health and Substance Abuse appointed a Working Group on Sexual Disorders and Sexual Health in order to revise and propose changes to ICD-10 categories. AIM Analyze ethical and legal implications in Brazil of the proposed ICD-11 diagnostic criteria for paraphilic disorders. METHODS A forensic working group of Brazilian experts in collaboration with representatives of WHO reviewed the proposed modifications to the classification of Disorders of Sexual Preference in ICD-10 (F65), which is recommended to be replaced by Paraphilic Disorders in ICD-11. Proposals were reviewed through a medicolegal lens, using a legal and policy analysis guide put forth by WHO. The premise of this review was to understand that, although the ICD classification is intended to provide a basis for clinical and statistical health interventions, medical diagnostics may also be entangled in the complex legal, normative, and political environment of various countries. MAIN OUTCOME MEASURE The most important proposed change to this section is to limit the concept of paraphilic disorders primarily to patterns of sexual arousal involving a focus on others who are unwilling or unable to consent, but this change has not affected the ethical and legal aspects of psychiatric functioning in the Brazil. RESULTS Because Brazilian criminal law is directed toward criminal behavior and not to specific psychiatric diagnoses, the changes proposed for ICD-11 are not expected to create obstacles to health services or to modify criminal sentencing. CLINICAL IMPLICATIONS Although ICD-11 has a number of changes in its content, there are no significant clinical implications in the Brazilian context, but a better clarity of conceptual definitions and diagnostic criteria. STRENGTHS & LIMITATIONS The study is conducted with people from different Brazilian states, which is important for a comprehensive view. On the other hand, considering that it is a very heterogeneous country, there is the limitation that an even wider scope of the study is not possible. CONCLUSION In the Brazilian context, the new guidelines for paraphilic disorders contribute to clinical utility and are not expected to create difficulties related to the legal, social, and economic consequences of sexual offenses in the country. Abdalla-Filho E, de Jesus Mari J, Diehl A, et al. Forensic Implications of the New Classification of ICD-11 Paraphilic Disorders in Brazil. J Sex Med 2019; 16:1814-1819.
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Affiliation(s)
| | - Jair de Jesus Mari
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Alessandra Diehl
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Denise Leite Vieira
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | | | | | - Geoffrey M Reed
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland; Global Mental Health Program, Department of Psychiatry, Columbia University, New York, NY, USA
| | | | - Quirino Cordeiro
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil; Department of Psychiatry, Santa Casa de São Paulo Medical School, São Paulo, Brazil
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de Queiroz Constantino Miguel A, Sandi Madruga C, Simões V, Yamauchi R, da Silva CJ, McDonell M, McPherson S, Roll J, Laranjeira RR, de Jesus Mari J. Contingency management is effective in promoting abstinence and retention in treatment among crack cocaine users with a previous history of poor treatment response: a crossover trial. Psicol Reflex Crit 2019; 32:14. [PMID: 32026092 PMCID: PMC6967308 DOI: 10.1186/s41155-019-0127-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 06/13/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Crack use has become a severe health problem in Brazil. Contingency management has shown robust evidence of efficacy in the treatment of cocaine use disorder (CUD) in high-income countries; however, it is still unclear how this intervention can impact treatment in low-income countries. OBJECTIVE To evaluate the efficacy of contingency management in the treatment of CUD among individuals with a previous history of poor treatment response in Brazil. METHODS Six months after the end of treatment, 32 participants previously allocated to the usual care condition (UCC) were invited to receive an additional 12 weeks of treatment in a contingency management condition (CMC), and 16 accepted the invitation. We compared data obtained from only the 16 participants (14 male) exposed to both treatment conditions. RESULTS Participants attended more treatment sessions and were retained in treatment for a longer period during the CMC than during the UCC (p < .01 for both). The proportion of negative cocaine samples submitted, the mean longest duration of cocaine abstinence, and the odds of being abstinent from cocaine during the 12 weeks of treatment were significantly higher during treatment in the CMC when compared to the UCC (p < .05). CONCLUSIONS This study provides further evidence that contingency management is effective in promoting abstinence and retention in treatment among individuals with CUD with a history of poor treatment response. Our findings argue for the incorporation of CM among public treatment services for CUD in Brazil. TRIAL REGISTRATION This study was registered at ClinicalTrials.gov as NCT01815645 on March 21, 2013.
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Affiliation(s)
- André de Queiroz Constantino Miguel
- National Institute of Policies on Alcohol and Drugs (INPAD) of the Department of Psychiatry and Medical Psychology, Federal University of São Paulo (UNIFESP), Rua: Dr. Diogo de Faria, 1036, 3º Andar–Vila Clementino, São Paulo, SP Brazil
- Department of Psychiatry and Medical Psychology, Federal University of São Paulo (UNIFESP), Rua Borges Lagoa, 570 – 1o andar – Vila Clementino, São Paulo, SP 04038-030 Brazil
- Spokane Valley, USA
| | - Clarice Sandi Madruga
- National Institute of Policies on Alcohol and Drugs (INPAD) of the Department of Psychiatry and Medical Psychology, Federal University of São Paulo (UNIFESP), Rua: Dr. Diogo de Faria, 1036, 3º Andar–Vila Clementino, São Paulo, SP Brazil
- Department of Psychiatry and Medical Psychology, Federal University of São Paulo (UNIFESP), Rua Borges Lagoa, 570 – 1o andar – Vila Clementino, São Paulo, SP 04038-030 Brazil
| | - Viviane Simões
- National Institute of Policies on Alcohol and Drugs (INPAD) of the Department of Psychiatry and Medical Psychology, Federal University of São Paulo (UNIFESP), Rua: Dr. Diogo de Faria, 1036, 3º Andar–Vila Clementino, São Paulo, SP Brazil
| | - Rodolfo Yamauchi
- National Institute of Policies on Alcohol and Drugs (INPAD) of the Department of Psychiatry and Medical Psychology, Federal University of São Paulo (UNIFESP), Rua: Dr. Diogo de Faria, 1036, 3º Andar–Vila Clementino, São Paulo, SP Brazil
| | - Claudio Jerônimo da Silva
- National Institute of Policies on Alcohol and Drugs (INPAD) of the Department of Psychiatry and Medical Psychology, Federal University of São Paulo (UNIFESP), Rua: Dr. Diogo de Faria, 1036, 3º Andar–Vila Clementino, São Paulo, SP Brazil
| | - Michael McDonell
- Program of Excellence in Addictions Research, Washington State University, P.O Box 1469, Spokane, WA USA
| | - Sterling McPherson
- Program of Excellence in Addictions Research, Washington State University, P.O Box 1469, Spokane, WA USA
| | - John Roll
- Program of Excellence in Addictions Research, Washington State University, P.O Box 1469, Spokane, WA USA
| | - Ronaldo Ramos Laranjeira
- National Institute of Policies on Alcohol and Drugs (INPAD) of the Department of Psychiatry and Medical Psychology, Federal University of São Paulo (UNIFESP), Rua: Dr. Diogo de Faria, 1036, 3º Andar–Vila Clementino, São Paulo, SP Brazil
- Department of Psychiatry and Medical Psychology, Federal University of São Paulo (UNIFESP), Rua Borges Lagoa, 570 – 1o andar – Vila Clementino, São Paulo, SP 04038-030 Brazil
| | - Jair de Jesus Mari
- Department of Psychiatry and Medical Psychology, Federal University of São Paulo (UNIFESP), Rua Borges Lagoa, 570 – 1o andar – Vila Clementino, São Paulo, SP 04038-030 Brazil
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Vilela TDR, Rocha MMD, Figlie NB, Mari JDJ. Association between psychosocial stressors with emotional and behavioral problems among children of low-income addicted families living in Brazil. Child Abuse Negl 2019; 92:12-21. [PMID: 30901614 DOI: 10.1016/j.chiabu.2019.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 02/21/2019] [Accepted: 03/04/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Children exposed to substance use in their families are vulnerable to multiple risk factors in their development and at increased risk for emotional and behavioral problems. The aims of the study were as follows 1) estimate the prevalence of emotional and behavioral problems among children aged 6-11 years old, living with addicted family members in a low-income urban community of São Paulo, Southeastern Brazil; 2) evaluate the children's exposure to family psychosocial stressors and substance use; and 3) investigate the factors related to the increased risk of emotional and behavioral problems and substance use. METHODS A cross-sectional study was conducted among 101 children aged 6-11 years old (M = 9.16 years, SD = 1.61). The instruments used were a sociodemographic questionnaire, the Child Behavior Checklist (CBCL) and the Psychosocial Stress Factors (PSF). RESULTS High prevalence of problems was found for this sample: the CBCL showed 26.7% of clinical scores for Internalizing Problems, 40.6% for Externalizing Problems, and 40.6% for Total Problems. Exposure to family psychosocial stressors was also high, including severe disease (33%), physical aggression (28.9%), death (27.8%), psychiatric hospitalization (16.7%), suicide attempts (15.5%), and suicide (9.3%). Exposure to these family stressors was associated with an increase of two to four times in the prevalence of internalizing and externalizing problems. CONCLUSIONS Children exposed to substance abusers have more mental health problems than general population, even when compared to peers living in similar low-income areas. This is a group that should be target of a selective preventive intervention.
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Affiliation(s)
| | - Marina Monzani da Rocha
- Developmental Disorders Post-Graduate Program, Mackenzie Presbyterian University, São Paulo, SP, Brazil
| | - Neliana Buzi Figlie
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Jair de Jesus Mari
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
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Cogo-Moreira H, Lúcio PS, Swardfager W, Gadelha A, Mari JDJ, Miguel EC, Rohde LA, Salum GA. Comparability of an ADHD Latent Trait Between Groups: Disentangling True Between-Group Differences From Measurement Problems. J Atten Disord 2019; 23:712-720. [PMID: 28478691 DOI: 10.1177/1087054717707047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this study is to investigate measurement invariance (MI) for an ADHD latent trait across different sociodemographic groups (sex, age, and maternal education), IQs, and co-occurring psychiatric diagnoses. METHOD Participants were 2,299 children aged 6 to 14 years. ADHD symptoms were assessed by parent report using the Development and Well-Being Assessment (DAWBA). MI was tested through multigroup confirmatory factor analysis and multiple indicators multiple causes models. RESULTS In a bifactor model including a general ADHD factor and three specific factors (hyperactivity, inattention, and impulsivity), invariance properties were demonstrated and no individual items showed differential functioning. The ADHD general factor was higher in boys and in those with psychiatric disorders. Younger age predicted hyperactivity. Lower IQ and higher level of education of the mother predicted inattention. CONCLUSION The ADHD trait, as measured by the DAWBA, functions in the same way, and with equivalent scale, revealing true differences in ADHD symptoms based on those.
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Affiliation(s)
| | - Patrícia Silva Lúcio
- 1 Federal University of São Paulo, Brazil.,2 State University of Londrina, Paraná, Brazil
| | | | | | - Jair de Jesus Mari
- 1 Federal University of São Paulo, Brazil.,4 National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil
| | - Eurípedes Constantino Miguel
- 4 National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil.,5 University of São Paulo, Brazil
| | - Luis Augusto Rohde
- 4 National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil.,6 Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Giovanni A Salum
- 4 National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil.,6 Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Belangero SI, Ota VK, Gadelha A, Berberian AA, Assunção-Leme IBD, Noto C, Christofolini DM, Bellucco FT, Santoro ML, Mazzotti DR, Zugman A, Melaragno MI, Smith MAC, Pellegrino R, Hakonarson H, Cordeiro Q, Moretti PN, Bressan RA, Mari JDJ, Jackowski AP. DGCR2 influences cortical thickness through a mechanism independent of schizophrenia pathogenesis. Psychiatry Res 2019; 274:391-394. [PMID: 30901624 DOI: 10.1016/j.psychres.2019.02.068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 01/03/2019] [Accepted: 02/27/2019] [Indexed: 01/17/2023]
Abstract
We investigated the role of DGCR2, a corticogenesis-related gene, on schizophrenia (SZ) and its subphenotypes, including brain morphology. A total of 221 SZ patients, 263 controls and 70 antipsychotic-naïve first episode of psychosis (FEP) were genotyped for 17 DGCR2 polymorphisms. While no association between DGCR2 polymorphisms and SZ was found, the missense variant rs2072123 was associated to left rostral anterior cingulate thickness, showing that DGCR2 seems not to be associated directly with the SZ but might be influencing the brain morphology. We also showed a DGCR2 downregulation in SZ patients when compared to controls and FEP.
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Affiliation(s)
- Sintia Iole Belangero
- Disciplina de Genética, Departamento de Morfologia e Genética, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil; Laboratório Interdisciplinar de Neurociências Clínicas (LiNC), Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.
| | - Vanessa Kiyomi Ota
- Disciplina de Genética, Departamento de Morfologia e Genética, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Ary Gadelha
- Laboratório Interdisciplinar de Neurociências Clínicas (LiNC), Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil; Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Arthur Almeida Berberian
- Laboratório Interdisciplinar de Neurociências Clínicas (LiNC), Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil; Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Idaiane Batista de Assunção-Leme
- Laboratório Interdisciplinar de Neurociências Clínicas (LiNC), Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil; Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Cristiano Noto
- Laboratório Interdisciplinar de Neurociências Clínicas (LiNC), Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil; Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Denise Maria Christofolini
- Disciplina de Genética, Departamento de Morfologia e Genética, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil; Department of Collective Health, Faculdade de Medicina do ABC, Human Reproduction and Genetic Center, Santo André, Brazil
| | - Fernanda Teixeira Bellucco
- Disciplina de Genética, Departamento de Morfologia e Genética, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Marcos Leite Santoro
- Disciplina de Genética, Departamento de Morfologia e Genética, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil; Laboratório Interdisciplinar de Neurociências Clínicas (LiNC), Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil; Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Diego Robles Mazzotti
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA, United States
| | - André Zugman
- Laboratório Interdisciplinar de Neurociências Clínicas (LiNC), Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil; Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Maria Isabel Melaragno
- Disciplina de Genética, Departamento de Morfologia e Genética, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Marilia Arruda Cardoso Smith
- Disciplina de Genética, Departamento de Morfologia e Genética, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Renata Pellegrino
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Hakon Hakonarson
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Quirino Cordeiro
- Departamento de Psiquiatria, Santa Casa School of Medical Sciences, São Paulo, Brazil
| | - Patricia Natalia Moretti
- Disciplina de Genética, Departamento de Morfologia e Genética, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil; Faculdade de Medicina, Universidade de Brasília (UNB), Brasília, Brazil
| | - Rodrigo Affonseca Bressan
- Laboratório Interdisciplinar de Neurociências Clínicas (LiNC), Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil; Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Jair de Jesus Mari
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Andrea Parolin Jackowski
- Laboratório Interdisciplinar de Neurociências Clínicas (LiNC), Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil; Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
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Reed GM, First MB, Kogan CS, Hyman SE, Gureje O, Gaebel W, Maj M, Stein DJ, Maercker A, Tyrer P, Claudino A, Garralda E, Salvador‐Carulla L, Ray R, Saunders JB, Dua T, Poznyak V, Medina‐Mora ME, Pike KM, Ayuso‐Mateos JL, Kanba S, Keeley JW, Khoury B, Krasnov VN, Kulygina M, Lovell AM, de Jesus Mari J, Maruta T, Matsumoto C, Rebello TJ, Roberts MC, Robles R, Sharan P, Zhao M, Jablensky A, Udomratn P, Rahimi‐Movaghar A, Rydelius P, Bährer‐Kohler S, Watts AD, Saxena S. Innovations and changes in the ICD-11 classification of mental, behavioural and neurodevelopmental disorders. World Psychiatry 2019; 18:3-19. [PMID: 30600616 PMCID: PMC6313247 DOI: 10.1002/wps.20611] [Citation(s) in RCA: 292] [Impact Index Per Article: 58.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Following approval of the ICD-11 by the World Health Assembly in May 2019, World Health Organization (WHO) member states will transition from the ICD-10 to the ICD-11, with reporting of health statistics based on the new system to begin on January 1, 2022. The WHO Department of Mental Health and Substance Abuse will publish Clinical Descriptions and Diagnostic Guidelines (CDDG) for ICD-11 Mental, Behavioural and Neurodevelopmental Disorders following ICD-11's approval. The development of the ICD-11 CDDG over the past decade, based on the principles of clinical utility and global applicability, has been the most broadly international, multilingual, multidisciplinary and participative revision process ever implemented for a classification of mental disorders. Innovations in the ICD-11 include the provision of consistent and systematically characterized information, the adoption of a lifespan approach, and culture-related guidance for each disorder. Dimensional approaches have been incorporated into the classification, particularly for personality disorders and primary psychotic disorders, in ways that are consistent with current evidence, are more compatible with recovery-based approaches, eliminate artificial comorbidity, and more effectively capture changes over time. Here we describe major changes to the structure of the ICD-11 classification of mental disorders as compared to the ICD-10, and the development of two new ICD-11 chapters relevant to mental health practice. We illustrate a set of new categories that have been added to the ICD-11 and present the rationale for their inclusion. Finally, we provide a description of the important changes that have been made in each ICD-11 disorder grouping. This information is intended to be useful for both clinicians and researchers in orienting themselves to the ICD-11 and in preparing for implementation in their own professional contexts.
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Affiliation(s)
- Geoffrey M. Reed
- Department of Mental Health and Substance AbuseWorld Health OrganizationGenevaSwitzerland,Department of PsychiatryColumbia University Medical CenterNew YorkNYUSA
| | - Michael B. First
- Department of PsychiatryColumbia University Medical CenterNew YorkNYUSA,New York State Psychiatric InstituteNew YorkNYUSA
| | - Cary S. Kogan
- School of PsychologyUniversity of OttawaOttawaONCanada
| | - Steven E. Hyman
- Stanley Center for Psychiatric ResearchBroad Institute of Harvard and Massachusetts Institute of TechnologyCambridgeMAUSA
| | - Oye Gureje
- Department of PsychiatryUniversity of IbadanIbadanNigeria
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical FacultyHeinrich‐Heine UniversityDüsseldorfGermany
| | - Mario Maj
- Department of PsychiatryUniversity of Campania “L. Vanvitelli”NaplesItaly
| | - Dan J. Stein
- Department of PsychiatryUniversity of Cape Town, and South African Medical Research Council Unit on Risk and Resilience in Mental DisordersCape TownSouth Africa
| | | | - Peter Tyrer
- Centre for Mental HealthImperial CollegeLondonUK
| | - Angelica Claudino
- Department of PsychiatryUniversidade Federal de São Paulo (UNIFESP/EPM)São PauloBrazil
| | | | - Luis Salvador‐Carulla
- Research School of Population HealthAustralian National UniversityCanberraACTAustralia
| | - Rajat Ray
- National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - John B. Saunders
- Centre for Youth Substance Abuse ResearchUniversity of QueenslandBrisbaneQLDAustralia
| | - Tarun Dua
- Department of Mental Health and Substance AbuseWorld Health OrganizationGenevaSwitzerland
| | - Vladimir Poznyak
- Department of Mental Health and Substance AbuseWorld Health OrganizationGenevaSwitzerland
| | | | - Kathleen M. Pike
- Department of PsychiatryColumbia University Medical CenterNew YorkNYUSA
| | - José L. Ayuso‐Mateos
- Department of PsychiatryUniversidad Autonoma de Madrid; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM); Instituto de Investigación Sanitaria La PrincesaMadridSpain
| | | | - Jared W. Keeley
- Department of PsychologyVirginia Commonwealth UniversityRichmondVAUSA
| | - Brigitte Khoury
- Department of PsychiatryAmerican University of Beirut Medical CenterBeirutLebanon
| | - Valery N. Krasnov
- Moscow Research Institute of PsychiatryNational Medical Research Centre for Psychiatry and NarcologyMoscowRussian Federation
| | - Maya Kulygina
- Moscow Research Institute of PsychiatryNational Medical Research Centre for Psychiatry and NarcologyMoscowRussian Federation
| | - Anne M. Lovell
- Institut National de la Santé et de la Recherche Médicale U988ParisFrance
| | - Jair de Jesus Mari
- Department of PsychiatryUniversidade Federal de São Paulo (UNIFESP/EPM)São PauloBrazil
| | | | | | - Tahilia J. Rebello
- Department of PsychiatryColumbia University Medical CenterNew YorkNYUSA,New York State Psychiatric InstituteNew YorkNYUSA
| | - Michael C. Roberts
- Office of Graduate Studies and Clinical Child Psychology ProgramUniversity of KansasLawrenceKSUSA
| | - Rebeca Robles
- National Institute of Psychiatry Ramón de la Fuente MuñizMexico CityMexico
| | - Pratap Sharan
- Department of PsychiatryAll India Institute of Medical SciencesNew DelhiIndia
| | - Min Zhao
- Shanghai Mental Health Center and Department of PsychiatryShanghai Jiao Tong University School of MedicineShanghaiPeople's Republic of China
| | - Assen Jablensky
- Centre for Clinical Research in NeuropsychiatryUniversity of Western AustraliaPerthWAAustralia
| | - Pichet Udomratn
- Department of PsychiatryPrince of Songkla UniversityHat YaiThailand
| | - Afarin Rahimi‐Movaghar
- Iranian National Center for Addiction Studies, Tehran University of Medical SciencesTehranIran
| | - Per‐Anders Rydelius
- Department of Child and Adolescent PsychiatryKarolinska InstituteStockholmSweden
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Moriyama TS, van Os J, Gadelha A, Pan PM, Salum GA, Manfro GG, Mari JDJ, Miguel EC, Rohde LA, Polanczyk GV, McGuire P, Bressan RA, Drukker M. Differences Between Self-Reported Psychotic Experiences, Clinically Relevant Psychotic Experiences, and Attenuated Psychotic Symptoms in the General Population. Front Psychiatry 2019; 10:782. [PMID: 31736802 PMCID: PMC6829673 DOI: 10.3389/fpsyt.2019.00782] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 10/01/2019] [Indexed: 12/26/2022] Open
Abstract
Purpose: Psychotic experiences in childhood (such as hearing voices or being suspicious) represent an important phenotype for early intervention. However, these experiences can be defined in several ways: self-reported psychotic experiences (SRPE) rely exclusively on the child's report, clinically validated psychotic experiences (CRPE) are based on clinical assessment, and attenuated psychotic symptoms (APS) represents a categorization to do with clinical relevance in relation to severity. Very few studies have investigated how these distinctions impact clinical and other domains. The present study aims to compare SRPE, CRPE, and APS among children and adolescents. Methods: This study is part of the Brazilian High-Risk Cohort Study for Psychiatric Disorders, in which 2,241 individuals aged 6-14 years provided self-ratings of 20 psychotic experiences using the Community Assessment of Psychic Experiences (CAPE). A trained psychologist conducted an interview to validate or reject reported experiences and to rate the presence of APS and affective flattening. In parallel, parents provided information about child mental health to an independent interviewer. We tested the association of mutually exclusive categories of non-validated SRPE (nSRPE), clinically validated PE below the threshold for APS (nCRPE), and APS (nSRPE = 33%, nCRPE = 11%, APS = 6%), with parents' information about the child's positive attributes and levels of psychopathology and psychologist assessment of blunted affect. Results: Most associations were qualitatively similar, and there was a dose-response in the strength of associations across categories, such that APS > nCRPE > nSRPE. Experiences in all three categories were associated with female sex. nSRPE were associated with overall levels of psychopathology, but to a lesser degree than nCRPE and APS. APS and nCRPE were associated with less positive attributes, with APS more so than nCRPE. Only APS was associated with affective flattening. Conclusions: In children and adolescents, SRPE, CRPE, and APS all index liability for psychopathology, but as clinician rated relevance increases, associations get stronger and become evident across more domains.
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Affiliation(s)
- Tais Silveira Moriyama
- Centro de Atendimento Especializado, Instituto Bairral de Psiquiatria, Itapira, Brazil.,Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil.,Brazilian High-Risk Cohort Study for Psychiatric Disorders, National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil.,Department of Psychiatry and Psychology, School of Mental Health and Neuroscience (MHeNS), Maastricht University Medical Centre (MUMC), Maastricht, Netherlands
| | - Jim van Os
- Department of Psychiatry and Psychology, School of Mental Health and Neuroscience (MHeNS), Maastricht University Medical Centre (MUMC), Maastricht, Netherlands.,Department of Psychosis Studies, King's College London, King's Health Partners, London, United Kingdom.,Department of Psychiatry, UMC Utrecht Brain Centre, Utrecht University Medical Centre, Utrecht, Netherlands
| | - Ary Gadelha
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil.,Brazilian High-Risk Cohort Study for Psychiatric Disorders, National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil
| | - Pedro Mario Pan
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil.,Brazilian High-Risk Cohort Study for Psychiatric Disorders, National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil
| | - Giovanni Abrahão Salum
- Brazilian High-Risk Cohort Study for Psychiatric Disorders, National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil.,Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Gisele Gus Manfro
- Brazilian High-Risk Cohort Study for Psychiatric Disorders, National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil.,Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Jair de Jesus Mari
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil.,Brazilian High-Risk Cohort Study for Psychiatric Disorders, National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil
| | - Eurípedes Constantino Miguel
- Brazilian High-Risk Cohort Study for Psychiatric Disorders, National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil.,Departamento de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Luis Augusto Rohde
- Brazilian High-Risk Cohort Study for Psychiatric Disorders, National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil.,Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Guilherme Vanoni Polanczyk
- Brazilian High-Risk Cohort Study for Psychiatric Disorders, National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil.,Departamento de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Philip McGuire
- Department of Psychosis Studies, King's College London, King's Health Partners, London, United Kingdom
| | - Rodrigo Affonseca Bressan
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil.,Brazilian High-Risk Cohort Study for Psychiatric Disorders, National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil.,Department of Psychiatry and Psychology, School of Mental Health and Neuroscience (MHeNS), Maastricht University Medical Centre (MUMC), Maastricht, Netherlands
| | - Marjan Drukker
- Department of Psychiatry and Psychology, School of Mental Health and Neuroscience (MHeNS), Maastricht University Medical Centre (MUMC), Maastricht, Netherlands
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Vistorte AOR, Ribeiro W, Ziebold C, Asevedo E, Evans-Lacko S, Keeley JW, Gonçalves DA, Palacios NG, Mari JDJ. Clinical decisions and stigmatizing attitudes towards mental health problems in primary care physicians from Latin American countries. PLoS One 2018; 13:e0206440. [PMID: 30440052 PMCID: PMC6237310 DOI: 10.1371/journal.pone.0206440] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 10/12/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The aim of this paper is to investigate how doctors working in primary health care in Latin American address patients with common mental disorders and to investigate how stigma can affect their clinical decisions. METHODS Using a cross-sectional design, we applied an online self-administered questionnaire to a sample of 550 Primary Care Physicians (PCPs) from Bolivia, Brazil, Cuba and Chile. The questionnaire collected information about sociodemographic variables, training and experience with mental health care. Clinicians' stigmatizing attitudes towards mental health were measured using the Mental Illness Clinicians' Attitudes Scale (MICA v4). The clinical decisions of PCPs were assessed through three clinical vignettes representing typical cases of depression, anxiety and somatization. RESULTS A total of 387 professionals completed the questionnaires (70.3% response rate). The 63.7% of the PCPs felt qualified to diagnose and treat people with common mental disorders. More than 90% of the PCPs from Bolivia, Cuba and Chile agreed to treat the patients presented in the three vignettes. We did not find significant differences between the four countries in the scores of the MICA v4 stigma levels, with a mean = 36.3 and SD = 8.3 for all four countries. Gender (p = .672), age (p = .171), training (p = .673) and years of experience (p = .28) were unrelated to stigma. In the two multivariate regression models, PCPs with high levels of stigma were more likely to refer them to a psychiatrist the patients with depression (OR = 1.03, 95% CI, 0.99 to 1.07 p<0.05) and somatoform symptoms somatoform (OR = 1.03, 95% CI, 1.00 to 1.07, p<0.05) to a psychiatrist. DISCUSSION The majority of PCPs in the four countries were inclined to treat patients with depression, anxiety and somatoform symptoms. PCPs with more levels of stigma were more likely to refer the patients with depression and somatoform symptoms to a psychiatrist. Stigmatizing attitudes towards mental disorders by PCPs might be important barriers for people with mental health problems to receive the treatment they need in primary care.
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Affiliation(s)
| | - Wagner Ribeiro
- London School of Economics and Political Science—Personal Social Services Research Unit, London, United Kingdom
| | - Carolina Ziebold
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Elson Asevedo
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
- Global Mental Health Program, Columbia University, New York, United States of America
| | - Sara Evans-Lacko
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
- King’s College London, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
| | - Jared W. Keeley
- Department of Psychology, Virginia Commonwealth University, Virginia, United States of America
| | | | | | - Jair de Jesus Mari
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
- King’s College London, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
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Reed GM, Keeley JW, Rebello TJ, First MB, Gureje O, Ayuso-Mateos JL, Kanba S, Khoury B, Kogan CS, Krasnov VN, Maj M, de Jesus Mari J, Sharan P, Stein DJ, Zhao M, Akiyama T, Andrews HF, Asevedo E, Cheour M, Domínguez-Martínez T, El-Khoury J, Fiorillo A, Grenier J, Gupta N, Kola L, Kulygina M, Leal-Leturia I, Luciano M, Lusu B, Martínez-López JNI, Matsumoto C, Odunleye M, Onofa LU, Paterniti S, Purnima S, Robles R, Sahu MK, Sibeko G, Zhong N, Gaebel W, Lovell AM, Maruta T, Pike KM, Roberts MC, Medina-Mora ME. Clinical utility of ICD-11 diagnostic guidelines for high-burden mental disorders: results from mental health settings in 13 countries. World Psychiatry 2018; 17:306-315. [PMID: 30192090 PMCID: PMC6127762 DOI: 10.1002/wps.20581] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
In this paper we report the clinical utility of the diagnostic guidelines for ICD-11 mental, behavioural and neurodevelopmental disorders as assessed by 339 clinicians in 1,806 patients in 28 mental health settings in 13 countries. Clinician raters applied the guidelines for schizophrenia and other primary psychotic disorders, mood disorders (depressive and bipolar disorders), anxiety and fear-related disorders, and disorders specifically associated with stress. Clinician ratings of the clinical utility of the proposed ICD-11 diagnostic guidelines were very positive overall. The guidelines were perceived as easy to use, corresponding accurately to patients' presentations (i.e., goodness of fit), clear and understandable, providing an appropriate level of detail, taking about the same or less time than clinicians' usual practice, and providing useful guidance about distinguishing disorder from normality and from other disorders. Clinicians evaluated the guidelines as less useful for treatment selection and assessing prognosis than for communicating with other health professionals, though the former ratings were still positive overall. Field studies that assess perceived clinical utility of the proposed ICD-11 diagnostic guidelines among their intended users have very important implications. Classification is the interface between health encounters and health information; if clinicians do not find that a new diagnostic system provides clinically useful information, they are unlikely to apply it consistently and faithfully. This would have a major impact on the validity of aggregated health encounter data used for health policy and decision making. Overall, the results of this study provide considerable reason to be optimistic about the perceived clinical utility of the ICD-11 among global clinicians.
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Affiliation(s)
- Geoffrey M Reed
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
- National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Jared W Keeley
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Tahilia J Rebello
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Michael B First
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Oye Gureje
- Department of Psychiatry, University of Ibadan, Ibadan, Nigeria
| | - José Luis Ayuso-Mateos
- Department of Psychiatry, Universidad Autonoma de Madrid; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM); Instituto de Investigación Sanitaria La Princesa, Madrid, Spain
| | - Shigenobu Kanba
- Department of Neuropsychiatry, Kyushu University, Fukuoka City, Japan
| | - Brigitte Khoury
- Department of Psychiatry, American University of Beirut Medical Center, Beirut, Lebanon
| | - Cary S Kogan
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Valery N Krasnov
- Moscow Research Institute of Psychiatry, National Medical Research Centre for Psychiatry and Narcology, Moscow, Russian Federation
| | - Mario Maj
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Jair de Jesus Mari
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Pratap Sharan
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Dan J Stein
- Department of Psychiatry, University of Cape Town and South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Cape Town, South Africa
| | - Min Zhao
- Shanghai Mental Health Center and Department of Psychiatry, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | | | - Howard F Andrews
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
- Department of Biostatistics, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Elson Asevedo
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Majda Cheour
- Department of Psychiatry, Tunis Al Manar University and Al Razi Hospital, Tunis, Tunisia
| | - Tecelli Domínguez-Martínez
- National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
- Cátedras CONACYT, National Council for Science and Technology, Mexico City, Mexico
| | - Joseph El-Khoury
- Department of Psychiatry, American University of Beirut Medical Center, Beirut, Lebanon
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Jean Grenier
- Institut du Savoir Montfort - Hôpital Montfort & Université d'Ottawa, Ottawa, ON, Canada
| | - Nitin Gupta
- Department of Psychiatry, Government Medical College and Hospital, Chandigarh, India
| | - Lola Kola
- Department of Psychiatry, University of Ibadan, Ibadan, Nigeria
| | - Maya Kulygina
- Moscow Research Institute of Psychiatry, National Medical Research Centre for Psychiatry and Narcology, Moscow, Russian Federation
| | - Itziar Leal-Leturia
- Department of Psychiatry, Universidad Autonoma de Madrid; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM); Instituto de Investigación Sanitaria La Princesa, Madrid, Spain
| | - Mario Luciano
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Bulumko Lusu
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | | | | | - Mayokun Odunleye
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | | | - Sabrina Paterniti
- Institute of Mental Health Research, Royal Ottawa Mental Health Centre, and Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
| | - Shivani Purnima
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Rebeca Robles
- National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Manoj K Sahu
- Pt. Jawahar Lal Nehru Memorial Medical College, Raipur, Chhattisgarh, India
| | - Goodman Sibeko
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Na Zhong
- Shanghai Mental Health Center and Department of Psychiatry, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Anne M Lovell
- Institut National de la Santé et de la Recherche Médicale U988, Paris, France
| | - Toshimasa Maruta
- Health Management Center, Seitoku University, Matsudo City, Japan
| | - Kathleen M Pike
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Michael C Roberts
- Office of Graduate Studies and Clinical Child Psychology Program, University of Kansas, Lawrence, KS, USA
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Moriyama TS, Drukker M, Gadelha A, Pan PM, Salum GA, Manfro GG, Mari JDJ, Miguel EC, Rohde LA, Polanczyk GV, van Os J, Bressan RA. The association between psychotic experiences and traumatic life events: the role of the intention to harm. Psychol Med 2018; 48:2235-2246. [PMID: 29331167 DOI: 10.1017/s0033291717003762] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Previous work showed traumatic life events (TLE) with intention to harm, like bullying and abuse, to be more strongly associated with psychotic experiences (PE) than other types of trauma, like accidents. However, this association is subject to reporting bias and can be confounded by demographic characteristics and by differences in dose of exposure across different trauma categories. We studied the association between TLE with and without intention to harm and PE, taking into account potential confounders and biases. METHODS A total of 2245 children and adolescents aged 6-14 years were interviewed by psychologists. The interview included the presence of 20 PE (both self-report and psychologist evaluation). In addition, parents provided information on child exposure to trauma, mental health and PE. RESULTS Results showed no significant association between TLE without intention to harm only and PE for the three methods of assessment of PE (self-report, parent report and psychologist rating). On the other hand, there was a positive association between PE and TLE in groups exposed to traumatic experiences with intention to harm (with intention to harm only and with and without intention to harm). Results remained significant after controlling for demographic and clinical confounders, but this positive association was no longer significant after adjusting for the number of TLE. CONCLUSIONS TLE with intention to harm display a stronger association with PE than TLE without intention to harm, and this difference is likely reducible to a greater level of traumatic exposure associated with TLE with intention to harm.
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Affiliation(s)
| | - Marjan Drukker
- Department of Psychiatry and Psychology,School of Mental Health and Neuroscience (MHeNS),Maastricht University Medical Centre (MUMC),Maastricht,The Netherlands
| | - Ary Gadelha
- Department of Psychiatry,Federal University of São Paulo,São Paulo,Brazil
| | - Pedro Mario Pan
- Department of Psychiatry,Federal University of São Paulo,São Paulo,Brazil
| | - Giovanni Abrahão Salum
- National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq),São Paulo,Brazil
| | - Gisele Gus Manfro
- National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq),São Paulo,Brazil
| | - Jair de Jesus Mari
- Department of Psychiatry,Federal University of São Paulo,São Paulo,Brazil
| | | | - Luis Augusto Rohde
- National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq),São Paulo,Brazil
| | - Guilherme Vanoni Polanczyk
- National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq),São Paulo,Brazil
| | - Jim van Os
- Department of Psychiatry and Psychology,School of Mental Health and Neuroscience (MHeNS),Maastricht University Medical Centre (MUMC),Maastricht,The Netherlands
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Araujo JA, Campos MR, Santos MVFD, Gonçalves DA, Mari JDJ, Tófoli LF, Ballester D, Fortes S. Dor lombar e transtornos mentais comuns na Estratégia Saúde da Família: uma associação pouco reconhecida. Rev Bras Med Fam Comunidade 2018. [DOI: 10.5712/rbmfc13(40)1740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objetivo: Descrever o perfil sociodemográfico dos pacientes atendidos na Estratégia Saúde da Família de quatro capitais brasileiras (Rio de Janeiro, São Paulo, Porto Alegre e Fortaleza) com dor lombar e investigar a associação entre dor lombar e depressão, ansiedade e somatização. Métodos: Estudo de corte transversal com 1857 pacientes atendidos nos anos de 2009 (setembro a novembro) e 2010 (junho a agosto). Instrumentos: rastreio de somatização (SOMS-2), avaliação de ansiedade e depressão (HAD), Questionário Geral do Paciente, para dados sociodemográficos e o Formulário do Profissional Assistente, com as informações referentes as consultas. A dor lombar foi analisada a partir da frequência de três diferentes formas de apresentação: queixa autorreferida pelo paciente, sintoma registrado pelo médico e diagnóstico de lombalgia confirmado pelo médico. Resultados: 77,3% eram mulheres com mais de quatro anos de estudo e renda per capita inferior a um salário mínimo e meio. Encontramos associação significativa de queixa de dor lombar com ansiedade (OR=1,5, 95% IC 1,02-2,16) e somatização (OR=1,8, 95% IC 1,12-2,88), mas não com depressão. Pacientes que apresentavam queixa de dor lombar, porém sem registro do sintoma pelo médico, apresentaram associações ainda mais fortes com ansiedade (OR=1,6, 95% IC 1,03-2,63) e somatização (OR=2,3, 95% IC 1,33-3,99). A confirmação do diagnóstico de dor lombar pelo médico não se associou significativamente com nenhum transtorno. Conclusão: Considerando a dor lombar como uma das queixas de maior prevalência na Atenção Primária e sua associação significativa com ansiedade e somatização, recomenda-se a abordagem da ansiedade e somatização em pacientes com queixa de dor lombar.
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Sousa A, Cardoso AA, Kayo M, Gregorio G, de Jesus Mari J, Razzouk D. The Adaption of the Client Sociodemographic and Service Receipt Inventory for Costing Mental Health Services in Brazil. J Ment Health Policy Econ 2018; 21:131-142. [PMID: 30530873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 05/11/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND There is a scarcity of tested instruments for measuring mental health services and costs. The Client Sociodemographic Service Receipt Inventory (CSSRI) is the most used tool in economic evaluation in mental health in Europe; it was translated into five languages, and it was mainly used to evaluate deinstitutionalisation process in mental health system reform. AIMS OF THE STUDY To translate and adapt to the Brazilian healthcare system, and to test its inter-rater reliability, validity and its feasibility in a deinstitutionalized sample of psychiatric hospital living in residential facilities. METHOD The translation and adaptation of CSSRI to Brazilian context was done by a focus group with eight experts on public mental health services, covering all the available Brazilian healthcare services. Decisions on the extent of conceptual overlap between British and Brazilian version were discussed until reaching expert consensus. The inter-rater reliability and applicability of this version, called ``Inventário Sociodemográfico de Uso e Custos de Serviços - ISDUCS'', was tested in a sample of 30 subjects with moderate to severe mental disorders living in residential facilities. Because the lack of medical record or another source, ISDUCS's validity was assessed using Kappa coefficient agreement to compare between resident`s answers and their professional carers`answers. RESULTS The same structure of the original instrument was kept, with an additional list of items for costing consumable services. The main modifications were on items related to education, occupational status and on detailed descriptions of public health services. The agreement between two mental health raters was good to excellent for the majority of items, with Kappa coefficient ranged from 0.6 to 1.0. Because 43% of the sample was unable to answer questions about regularly taken medications and consultations with health professionals, an exploratory analysis was done to identify potentially related variables. Greater severity of psychiatric symptoms and lower independent living skills were related to the inability to answer these questions. Agreement between residents and carers was good to excellent for socio and demographic variables, living situation and occupational status, income, visits to a psychologist, occupational therapists and social workers. CONCLUSION ISDUCS is the first tool for economic evaluation including mental health services translated and adapted to Brazilian context. Despite the widespread use of CRSSI among people with schizophrenia in Europe, this study found that greater severity of symptoms led to high rate of missing responses. Inter-rater reliability was excellent as a whole. Small sample size didn't allow generalisation of results of this preliminary testing. IMPLICATIONS FOR HEALTH PROVISION AND USE ISDUCS may be suitable for people with mental illness but requires additional sources of information such as carers and medical records. ISDUCS could be used for monitoring health service use in general practice. IMPLICATIONS FOR HEALTH POLICIES Despite some limitations, this instrument was used to measure mental health service costs in three Brazilian studies, generating data for supporting local mental health policies, for boosting empirical research in the country and for supporting modelling studies. IMPLICATIONS FOR FURTHER RESEARCH It should be tested further in other health settings and samples.
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Affiliation(s)
| | | | | | | | | | - Denise Razzouk
- Centro de Economia em Saude Mental (CESM) Departamento de Psiquiatria, Universidade Federal de Sao Paulo (UNIFESP) Rua Borges Lagoa 570, 1 andar, Vila Clementino, Sao Paulo, 04038-000, Brazil,
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Aragão EIS, Campos MR, Portugal FB, Gonçalves DA, Mari JDJ, Fortes SLCL. Social Support patterns in Primary Health Care: differences between having physical diseases or mental disorders. Cien Saude Colet 2018; 23:2339-2350. [PMID: 30020386 DOI: 10.1590/1413-81232018237.21012016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 08/06/2016] [Indexed: 11/22/2022] Open
Abstract
The social support network is a health protective factor involving physical, mental and psychological aspects, providing a better quality of life, favoring better adaptation to adverse conditions, promoting resilience and mobilizing resources for a more effective coping with negative life events that can lead to illness. We aimed to analyze the association between physical diseases, common mental disorders and the social support network of patients serviced at primary care facilities in the cities of Rio de Janeiro and São Paulo through a cross-sectional study with 1,466 patients in the 18-65 years age group. We used the Social Network Index (SNI) to assess the support network through the categories of isolation and integration. The doctor/nurse completed the questionnaire to evaluate the physical disease diagnosis, while the Hospital Anxiety and Depression Scale was used to detect mental disorders. We found that the pattern of social support was different depending on the presence of physical diseases or mental disorders. Negative associations were found between diabetes and isolation; integration and anxiety; integration and depression. Positive associations were identified between isolation and anxiety and isolation and depression.
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Affiliation(s)
- Ellen Ingrid Souza Aragão
- Universidade do Estado do Rio de Janeiro. R. Vinte e Oito de Setembro 77, Maracanã. 22000-000 Rio de Janeiro RJ
| | | | | | | | - Jair de Jesus Mari
- Departamento de Psiquiatria, Universidade Federal de São Paulo. São Paulo SP Brasil
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Vistorte AOR, Ribeiro WS, Jaen D, Jorge MR, Evans-Lacko S, Mari JDJ. Stigmatizing attitudes of primary care professionals towards people with mental disorders: A systematic review. Int J Psychiatry Med 2018; 53:317-338. [PMID: 29807502 DOI: 10.1177/0091217418778620] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective To examine stigmatizing attitudes towards people with mental disorders among primary care professionals and to identify potential factors related to stigmatizing attitudes through a systematic review. Methods A systematic literature search was conducted in Medline, Lilacs, IBECS, Index Psicologia, CUMED, MedCarib, Sec. Est. Saúde SP, WHOLIS, Hanseníase, LIS-Localizador de Informação em Saúde, PAHO, CVSO-Regional, and Latindex, through the Virtual Health Library portal ( http://www.bireme.br website) through to June 2017. The articles included in the review were summarized through a narrative synthesis. Results After applying eligibility criteria, 11 articles, out of 19.109 references identified, were included in the review. Primary care physicians do present stigmatizing attitudes towards patients with mental disorders and show more negative attitudes towards patients with schizophrenia than towards those with depression. Older and more experience doctors have more stigmatizing attitudes towards people with mental illness compared with younger and less-experienced doctors. Health-care providers who endorse more stigmatizing attitudes towards mental illness were likely to be more pessimistic about the patient's adherence to treatment. Conclusions Stigmatizing attitudes towards people with mental disorders are common among physicians in primary care settings, particularly among older and more experienced doctors. Stigmatizing attitudes can act as an important barrier for patients to receive the treatment they need. The primary care physicians feel they need better preparation, training, and information to deal with and to treat mental illness, such as a user friendly and pragmatic classification system that addresses the high prevalence of mental disorders in primary care and community settings.
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Affiliation(s)
| | - Wagner Silva Ribeiro
- 1 Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil.,2 Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
| | - Denisse Jaen
- 1 Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Miguel R Jorge
- 1 Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Sara Evans-Lacko
- 2 Personal Social Services Research Unit, London School of Economics and Political Science, London, UK.,3 Health Service and Population Research Department, Institute of Psychiatry Psychology & Neuroscience, King's College London, London, UK
| | - Jair de Jesus Mari
- 1 Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil.,3 Health Service and Population Research Department, Institute of Psychiatry Psychology & Neuroscience, King's College London, London, UK
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Reed GM, Sharan P, Rebello TJ, Keeley JW, Elena Medina-Mora M, Gureje O, Luis Ayuso-Mateos J, Kanba S, Khoury B, Kogan CS, Krasnov VN, Maj M, de Jesus Mari J, Stein DJ, Zhao M, Akiyama T, Andrews HF, Asevedo E, Cheour M, Domínguez-Martínez T, El-Khoury J, Fiorillo A, Grenier J, Gupta N, Kola L, Kulygina M, Leal-Leturia I, Luciano M, Lusu B, Nicolas J, Martínez-López I, Matsumoto C, Umukoro Onofa L, Paterniti S, Purnima S, Robles R, Sahu MK, Sibeko G, Zhong N, First MB, Gaebel W, Lovell AM, Maruta T, Roberts MC, Pike KM. The ICD-11 developmental field study of reliability of diagnoses of high-burden mental disorders: results among adult patients in mental health settings of 13 countries. World Psychiatry 2018; 17:174-186. [PMID: 29856568 PMCID: PMC5980511 DOI: 10.1002/wps.20524] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Reliable, clinically useful, and globally applicable diagnostic classification of mental disorders is an essential foundation for global mental health. The World Health Organization (WHO) is nearing completion of the 11th revision of the International Classification of Diseases and Related Health Problems (ICD-11). The present study assessed inter-diagnostician reliability of mental disorders accounting for the greatest proportion of global disease burden and the highest levels of service utilization - schizophrenia and other primary psychotic disorders, mood disorders, anxiety and fear-related disorders, and disorders specifically associated with stress - among adult patients presenting for treatment at 28 participating centers in 13 countries. A concurrent joint-rater design was used, focusing specifically on whether two clinicians, relying on the same clinical information, agreed on the diagnosis when separately applying the ICD-11 diagnostic guidelines. A total of 1,806 patients were assessed by 339 clinicians in the local language. Intraclass kappa coefficients for diagnoses weighted by site and study prevalence ranged from 0.45 (dysthymic disorder) to 0.88 (social anxiety disorder) and would be considered moderate to almost perfect for all diagnoses. Overall, the reliability of the ICD-11 diagnostic guidelines was superior to that previously reported for equivalent ICD-10 guidelines. These data provide support for the suitability of the ICD-11 diagnostic guidelines for implementation at a global level. The findings will inform further revision of the ICD-11 diagnostic guidelines prior to their publication and the development of programs to support professional training and implementation of the ICD-11 by WHO member states.
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Affiliation(s)
- Geoffrey M Reed
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
- National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Pratap Sharan
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Tahilia J Rebello
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Jared W Keeley
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Oye Gureje
- Department of Psychiatry, University of Ibadan, Nigeria
| | - José Luis Ayuso-Mateos
- Department of Psychiatry, Universidad Autonoma de Madrid, IIS-P and Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Shigenobu Kanba
- Department of Neuropsychiatry, Kyushu University, Fukuoka City, Japan
| | - Brigitte Khoury
- Department of Psychiatry, American University of Beirut Medical Center, Beirut, Lebanon
| | - Cary S Kogan
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Valery N Krasnov
- Moscow Research Institute of Psychiatry, National Medical Research Centre for Psychiatry and Narcology, Moscow, Russian Federation
| | - Mario Maj
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Jair de Jesus Mari
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Dan J Stein
- Department of Psychiatry, University of Cape Town and South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Cape Town, South Africa
| | - Min Zhao
- Shanghai Mental Health Center and Department of Psychiatry, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | | | - Howard F Andrews
- New York State Psychiatric Institute, New York, NY, USA
- Departments of Biostatistics and Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Elson Asevedo
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Majda Cheour
- Department of Psychiatry, Tunis Al Manar University and Al Razi Hospital, Tunis, Tunisia
| | - Tecelli Domínguez-Martínez
- National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
- Cátedras CONACYT, National Council for Science and Technology, Mexico City, Mexico
| | - Joseph El-Khoury
- Department of Psychiatry, American University of Beirut Medical Center, Beirut, Lebanon
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Jean Grenier
- Institut du Savoir Montfort - Hôpital Montfort & Université d'Ottawa, Ottawa, Ontario, Canada
| | - Nitin Gupta
- Department of Psychiatry, Government Medical College and Hospital, Chandigarh, India
| | - Lola Kola
- Department of Psychiatry, University of Ibadan, Nigeria
| | - Maya Kulygina
- Moscow Research Institute of Psychiatry, National Medical Research Centre for Psychiatry and Narcology, Moscow, Russian Federation
| | - Itziar Leal-Leturia
- Department of Psychiatry, Universidad Autonoma de Madrid, IIS-P and Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Mario Luciano
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Bulumko Lusu
- Department of Psychiatry, University of Cape Town and South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Cape Town, South Africa
| | | | - I Martínez-López
- National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | | | | | - Sabrina Paterniti
- Institute of Mental Health Research, Royal Ottawa Mental Health Centre, and Department of Psychiatry, University of Ottawa, Ontario, Canada
| | - Shivani Purnima
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Rebeca Robles
- National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Manoj K Sahu
- Pt. Jawahar Lal Nehru Memorial Medical College, Raipur, Chhattisgarh, India
| | - Goodman Sibeko
- Department of Psychiatry, University of Cape Town and South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Cape Town, South Africa
| | - Na Zhong
- Shanghai Mental Health Center and Department of Psychiatry, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Michael B First
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Anne M Lovell
- Institut National de la Santé et de la Recherche Médicale U988, Paris, France
| | - Toshimasa Maruta
- Health Management Center, Seitoku University, Matsudo City, Japan
| | - Michael C Roberts
- Office of Graduate Studies and Clinical Child Psychology Program, University of Kansas, Lawrence, KS, USA
| | - Kathleen M Pike
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
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Fatori D, Salum G, Itria A, Pan P, Alvarenga P, Rohde LA, Bressan R, Gadelha A, de Jesus Mari J, Conceição do Rosário M, Manfro G, Polanczyk G, Miguel EC, Graeff-Martins AS. The economic impact of subthreshold and clinical childhood mental disorders. J Ment Health 2018; 27:588-594. [DOI: 10.1080/09638237.2018.1466041] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Daniel Fatori
- Department of Psychiatry, University of Sao Paulo Medical School, Sao Paulo, Brazil,
| | - Giovanni Salum
- Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil,
| | - Alexander Itria
- Department of Collective Health, Institute of Tropical Pathology and Public Health, Federal University of Goias, Goiania, Brazil, and
| | - Pedro Pan
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Pedro Alvarenga
- Department of Psychiatry, University of Sao Paulo Medical School, Sao Paulo, Brazil,
| | - Luis Augusto Rohde
- Department of Psychiatry, University of Sao Paulo Medical School, Sao Paulo, Brazil,
- Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil,
| | - Rodrigo Bressan
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Ary Gadelha
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Jair de Jesus Mari
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | | | - Gisele Manfro
- Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil,
| | - Guilherme Polanczyk
- Department of Psychiatry, University of Sao Paulo Medical School, Sao Paulo, Brazil,
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Clemente J, Diehl A, Santana PROH, da Silva CJ, Pillon SC, Mari JDJ. Erectile Dysfunction Symptoms in Polydrug Abusers Seeking Treatment. Subst Use Misuse 2018; 53:704. [PMID: 29364759 DOI: 10.1080/10826084.2017.1413116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Jales Clemente
- a Psychiatric Department , Federal University of São Paulo (UNIFESP) , São Paulo , Brazil
| | - Alessandra Diehl
- a Psychiatric Department , Federal University of São Paulo (UNIFESP) , São Paulo , Brazil
| | | | | | - Sandra Cristina Pillon
- c Psychiatric Nursing and Human Science Department , University of São Paulo at Ribeirao Preto College of Nursing , Ribeirão Preto , Brazil
| | - Jair de Jesus Mari
- a Psychiatric Department , Federal University of São Paulo (UNIFESP) , São Paulo , Brazil
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dos Santos MM, Inoue SRV, Quintana MI, Blay SL, de Jesus Mari J, Andreoli SB. Prison is not the right place for people with mental disorders: the Brazilian case. Int Psychiatry 2018. [DOI: 10.1192/s1749367600004495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The large number of individuals with severe mental disorders in prisons worldwide has alarming implications, which leads to the question of the appropriateness of the prison system for people with this type of morbidity. This article discusses these implications, the problems in therapeutic approaches and the legal aspects in the Brazilian context.
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Lúcio PS, Moreira HC, Kida ADSB, Carvalho CAFD, Pinheiro ÂMV, Mari JDJ, Avila CRBD. Word Decoding Task: Item Analysis by IRT and Within-Group Norms. Psic : Teor e Pesq 2018. [DOI: 10.1590/0102.3772e3437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract This paper reports the performance of a representative sample of 747 students (52.5% female), from 2nd to 5th year of elementary education from private and public (83.8%) schools of Sao Paulo city. The children performed the Form A of Word Reading and Spelling Task (WRST) containing 48 low-frequency words presented in a card. Data were analyzed using models of Item Response Theory. We observed high levels of accuracy. The analysis selected 24 items, which presented low to moderate discrimination and difficulty indices. There were mean differences between grades, but not sex or school type. We report percentile norms for the grades for the WRST´S (Form) Reduced Version. The results support preceding studies with the word decoding tasks in Brazilian Portuguese, which attested to the quasi-regular character of that language.
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Lúcio PS, Salum G, Swardfager W, Mari JDJ, Pan PM, Bressan RA, Gadelha A, Rohde LA, Cogo-Moreira H. Testing Measurement Invariance across Groups of Children with and without Attention-Deficit/ Hyperactivity Disorder: Applications for Word Recognition and Spelling Tasks. Front Psychol 2017; 8:1891. [PMID: 29118733 PMCID: PMC5661119 DOI: 10.3389/fpsyg.2017.01891] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 10/12/2017] [Indexed: 11/13/2022] Open
Abstract
Although studies have consistently demonstrated that children with attention-deficit/hyperactivity disorder (ADHD) perform significantly lower than controls on word recognition and spelling tests, such studies rely on the assumption that those groups are comparable in these measures. This study investigates comparability of word recognition and spelling tests based on diagnostic status for ADHD through measurement invariance methods. The participants (n = 1,935; 47% female; 11% ADHD) were children aged 6–15 with normal IQ (≥70). Measurement invariance was investigated through Confirmatory Factor Analysis and Multiple Indicators Multiple Causes models. Measurement invariance was attested in both methods, demonstrating the direct comparability of the groups. Children with ADHD were 0.51 SD lower in word recognition and 0.33 SD lower in spelling tests than controls. Results suggest that differences in performance on word recognition and spelling tests are related to true mean differences based on ADHD diagnostic status. Implications for clinical practice and research are discussed.
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Affiliation(s)
- Patrícia S Lúcio
- Department of Psychology and Psychoanalysis, State University of Londrina, Londrina, Brazil.,Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Giovanni Salum
- Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.,National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil
| | - Walter Swardfager
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Jair de Jesus Mari
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil.,National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil
| | - Pedro M Pan
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil.,National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil
| | - Rodrigo A Bressan
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil.,National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil
| | - Ary Gadelha
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil.,National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil
| | - Luis A Rohde
- Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Hugo Cogo-Moreira
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
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Abstract
OBJECTIVE To assess erectile dysfunction (ED) symptom prevalence, sexual behavior conditions, and risk factors associated to ED in a male polydrug dependent sample. METHODS A cross-sectional design study was conducted with 102 substance-dependent male polydrug users who sought outpatient treatment in São Paulo, Brazil. Sociodemographic data, drug of choice, chronic disease questions, sexually transmitted infections, International Index of Erectile Function (IIEF) scale, Sexual Addiction Screening Test (SAST), and WHOQOL-Bref instrument were used. RESULTS The erectile dysfunction prevalence was 32.3% and it was related to the marital status (single) (p < 0.001), occupational status (fully unemployed) (p < 0.001), presenting a chronic disease (p = 0.027), and with types of sexual partnerships (occasional partner) (p < 0.001). Alcohol (73.5%), tobacco (79.4%), cannabis (83.3%), and cocaine (snorted 78.4% and smoked 42.2%) were the drugs of choice. The ED risk decreased when marital status was married (odds ratio = 3.2 CI95% 1.411-7.518) and with chronic disease (odds ratio 0.06 CI95% 0.00-0.97), while having occasional sexual partners increased 14 times ED risk (OR 14.0 CI95%1.62-122.18). There were no significant associations between quality of life, DOC and ED. CONCLUSION Approximately one third of the substance dependents in this sample presented ED. There is a need to integrate psychiatric and clinical care in substance treatment services, and to improve the provision of sexual health care and support available for this population.
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Affiliation(s)
- Jales Clemente
- a Psychiatric Department , Federal University of São Paulo (UNIFESP) , São Paulo , Brazil
| | - Alessandra Diehl
- a Psychiatric Department , Federal University of São Paulo (UNIFESP) , São Paulo , Brazil
| | | | | | - Sandra Cristina Pillon
- c Psychiatric Nursing and Human Science Department , University of Sao Paulo at Ribeirao Preto College of Nursing , Ribeirão Preto , Brazil
| | - Jair de Jesus Mari
- a Psychiatric Department , Federal University of São Paulo (UNIFESP) , São Paulo , Brazil
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49
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Goldberg DP, Lam TP, Minhas F, Razzaque B, Robles R, Bobes J, Iglesias C, Fortes S, Mari JDJ, Gask L, García JÁ, Dowell AC, Rosendal M, Reed GM. Primary care physicians' use of the proposed classification of common mental disorders for ICD-11. Fam Pract 2017; 34:574-580. [PMID: 28475675 DOI: 10.1093/fampra/cmx033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The World Health Organization is revising the classification of common mental disorders in primary care for ICD-11. Major changes from the ICD-10 primary care version have been proposed for: (i) mood and anxiety disorders; and (ii) presentations of multiple somatic symptoms (bodily stress syndrome). This three-part field study explored the implementation of the revised classification by primary care physicians (PCPs) in five countries. METHODS Participating PCPs in Brazil, China, Mexico, Pakistan and Spain were asked to use the revised classification, first in patients that they suspected might be psychologically distressed (Part 1), and second in patients with multiple somatic symptoms causing distress or disability not wholly attributable to a known physical pathology, or with high levels of health anxiety (Part 2). Patients referred to Part 1 or Part 2 underwent a structured diagnostic interview. Part 3 consisted of feedback from PCPs regarding the classification. RESULTS In Part 1, anxious depression was the most common disorder among referred patients. PCPs assigned the highest severity ratings to anxious depression, and the next highest to current depression; current anxiety was rated as least severe. Considerable overlap was found between bodily stress syndrome (BSS) and health anxiety (HA). The psychiatric interview recorded higher rates of mood and anxiety disorders diagnoses among patients with BSS than did PCPs. PCPs' satisfaction with the revised classification was high. CONCLUSIONS Results generally supported the inclusion of the new categories of anxious depression, BSS and HA for ICD-11 PHC and suggested that PCPs could implement these categories satisfactorily.
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Affiliation(s)
| | - Tai-Pong Lam
- University of Hong Kong, Hong Kong, People's Republic of China
| | | | | | - Rebeca Robles
- National Institute of Psychiatry 'Ramón de la Fuente Muñiz', Mexico City, Mexico
| | | | | | - Sandra Fortes
- Rio de Janeiro State University, Rio de Janeiro, Brazil
| | | | - Linda Gask
- University of Manchester, Manchester, UK
| | - José Ángel García
- National Institute of Psychiatry 'Ramón de la Fuente Muñiz', Mexico City, Mexico
| | | | - Marianne Rosendal
- Research Unit for General Practice, University of Southern Denmark, Denmark
| | - Geoffrey M Reed
- World Health Organization, Geneva, Switzerland.,Global Mental Health Program, Columbia University Medical Center, New York, USA
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50
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Cumbe VFJ, Pala AN, Palha AJP, Gaio ARP, Esteves MF, de Jesus Mari J, Wainberg M. Burnout syndrome and coping strategies in Portuguese oncology health care providers. ARCH CLIN PSYCHIAT 2017; 44:122-126. [PMID: 30498284 PMCID: PMC6258179 DOI: 10.1590/0101-60830000000135] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Burnout is a multidimensional syndrome and includes symptoms of emotional exhaustion, depersonalization, and reduced personal accomplishment at work. Oncology health care providers are at high risk to develop symptoms of burnout because of work-related stressors. Adaptive coping strategies adopted to deal with stressors may prevent the development of burnout. OBJECTIVE The present study aims to assess the association between burnout, functional coping strategies, and occupational factors in a sample of oncology providers, mostly nurses. METHODS Sociodemographic Questionnaire, the Maslach Burnout Inventory, and the Problem Solving Inventory "Inventário de Resolução de Problemas" were administered. Descriptive, correlational, and linear regression analyses were performed. RESULTS The study showed that emotional exhaustion correlated with lower levels of adaptive coping, less years of experience in Oncology, and a greater amount of hours worked per week. Personal accomplishment was associated with the adaptive coping strategies. No further statistically significant associations were identified. DISCUSSION Our findings support the importance of adaptive coping strategies in order to prevent symptoms of burnout when health professionals face potentially stressful occupational factors. Training aimed at improving adaptive coping skills may prevent burnout syndrome for health care professionals working in Oncology.
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Affiliation(s)
- Vasco F J Cumbe
- Department of Mental Health, Ministry of Health, Sofala Provincial Health Directorate, Beira, Mozambique
- Department of Medicine - Psychiatry, Beira Central Hospital, Beira, Mozambique
- Department of Psychiatry, Paulista School of Medicine, Federal University of São Paulo, São Paulo, SP, Brazil
| | - Andrea N Pala
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - António J P Palha
- Psychiatry and Mental Health, Faculty of Medicine of the University of Porto, FMUP
- Honorary Member of the World Psychiatric Association (WPA)
- Former President of the Portuguese Society of Psychiatry and Mental Health
| | - Ana R P Gaio
- Department of Mathematics, Faculty of Sciences of the University of Porto, FCUP
- Centre for Mathematics of the University of Porto, CMUP
| | - Manuel F Esteves
- Psychiatry and Mental Health, Faculty of Medicine of the University of Porto, FMUP
| | - Jair de Jesus Mari
- Department of Psychiatry, Paulista School of Medicine, Federal University of São Paulo, São Paulo, SP, Brazil
| | - Milton Wainberg
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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