BRUNO MENDONCA COELHO
Projetos de Pesquisa
Unidades Organizacionais
Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina
LIM/23 - Laboratório de Psicopatologia e Terapêutica Psiquiátrica, Hospital das Clínicas, Faculdade de Medicina
LIM/23 - Laboratório de Psicopatologia e Terapêutica Psiquiátrica, Hospital das Clínicas, Faculdade de Medicina
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article 0 Citação(ões) na Scopus Assessing skills in psychiatry: a methodological challenge(2011) COELHO, Bruno Mendonca; SANTANA, Geilson Lima- Correlates and prevalence of post-traumatic stress disorders in the Sa tilde o Paulo metropolitan area, Brazil(2022) COELHO, Bruno Mendonca; SANTANA, Geilson Lima; DANTAS, Heloisa de Souza; VIANA, Maria Carmen; ANDRADE, Laura Helena; WANG, Yuan-PangBackground: Post-traumatic stress disorder (PTSD) is a debilitating condition, which generates an extensive burden. We aimed to investigate in a huge metropolitan area, the prevalence of traumatic experiences, the development of PTSD, and its predictors. Methods: Traumatic experiences and PTSD were assessed in 5037 adult individuals of the general population. Cross-tabulations method assessed the prevalence of traumatic events and PTSD. Logistic regression models investigated predictors of lifetime and 12-month odds of PTSD and the conditional probability of developing PTSD for specific traumas. Results: Lifetime and 12-month diagnoses of PTSD were found in 3.2% and 1.6% of the sample. 'Witnessing anyone being injured or killed, or unexpectedly seeing a dead body' (35,7%) and 'being mugged or threatened with a weapon' (34.0%) were the two most reported traumas. The commonest events before PTSD onset were 'sudden unexpected death of a loved one' (34.0%), 'interpersonal violence' (31.0%), and 'threats to the physical integrity of others' (25.0%). Experiences related to ""interpersonal violence "" presented the highest conditional probability for PTSD (range 2.2-21.2%). Being 'sexually assaulted or molested' (21.2% total; 22.3% women; 0.0% men) and being 'raped' (18.8% total; 18.4% women; 20.1% men) were the two experiences with the highest odds for PTSD. While being female was a predictor of less exposure to any event (OR = 0.69), females were more prone to develop lifetime PTSD after exposure to an event (OR = 2.38). Conclusion: Traumatic events are frequent in the general population and a small group of traumatic events accounts for most cases of subsequent PTSD.
- The role of gender in the structure of networks of childhood adversity(2018) COELHO, Bruno Mendonca; SANTANA, Geilson Lima; DUARTE-GUERRA, Leorides Severo; VIANA, Maria Carmen; NETO, Francisco Lotufo; ANDRADE, Laura Helena; WANG, Yuan-PangThe objective of present study is to investigate the relationship between different childhood adversities. The potential impact of early adversity on prevention programs is discussed. Data on twelve childhood adversities was collected from a representative sample of 5037 members of the general population living in a large metropolitan area. Data were analyzed through network analysis, to estimate and compare network connectivity and centrality measures by gender. Over half the respondents had been exposed to at least one adversity during their earlier developmental stage. Among adversity-exposed persons, 48.4% presented simultaneous adversities, most of which were related to 'family dysfunction' and 'maltreatment' (mean = 2.9 adversities). Women reported more adversities than men (59.0% vs. 47.6%). Although the 'global' network connectivity across adversities was similar in both genders, 'regional' distinctions in the network structure were found. While 'neglect' and 'parental death' were more important for women than men, 'parental mental disorders' was more important for men. Gender-related childhood adversities were clustered experiences. Adversities related to 'early family dysfunction' and 'maltreatment' were prominent features in the networks of both boys and girls. Differential preventive and intervention programs should take into account gender-related patterns of exposure and reporting patterns of early adversity.
- Morbidity persistence and comorbidity of mood, anxiety, and eating disorders among preoperative bariatric patients(2017) DUARTE-GUERRA, Leorides Severo; COELHO, Bruno Mendonca; SANTO, Marco Aurelio; LOTUFO-NETO, Francisco; WANG, Yuan-PangThe current study investigates the patterns of disease persistence and comorbidity of psychiatric disorders among patients with class III obesity in pre-operative period. For 393 treatment-seeking patients with severe obesity recruited from a bariatric center, we ascertained their psychiatric diagnosis through Structured Clinical Interview for DSM-IV (SCID-I). Following, the frequency, persistence and comorbidity pattern of psychiatric disorders in this sample were determined. Current psychiatric disorders were observed in over half of patients during preoperative period, being anxiety disorders the most frequent diagnosis. For lifetime disorders, mood disorders were the most frequent diagnosis. Most of the sample presented 2 or more concurrent lifetime psychiatric disorders. While mood and eating disorders were frequent conditions, anxiety disorders were the most persistent conditions (the highest one month-to-lifetime prevalence ratio) and were significantly correlated with bipolar, depressive and eating disorders. Psychiatric disorders are frequent and enduring conditions among patients looking for bariatric surgery. Comorbid anxiety, mood, and eating disorders are remarkable features in treatment-seeking patients with obesity. Prognostic implications of preoperative psychiatric disorders on surgery outcome should be demonstrated prospectively in intervention studies.
- Association between childhood adversities and psychopathology onset throughout the lifespan: Findings from a large metropolitan population(2021) COELHO, Bruno Mendonca; ANDRADE, Laura Helena; SANTANA, Geilson Lima; VIANA, Maria Carmen; WANG, Yuan-PangBackground: Childhood adversities (ECA) are deleterious experiences that can occur during individuals' development, which has been associated with several negative health outcomes. Aim: Analyze the effect of ECA on the onset of DSM-IV disorders throughout life. Method: The Composite International Diagnostic Interview (CIDI) was used in a stratified, multistage area probability sample of 5037 individuals aged 18 or more to assess the presence of childhood adversities, 20 psychiatric disorders and their ages of onset. Discrete-time survival models were performed to estimate the odds of disorder onset. Data are from the Sao Paulo Megacity Mental Health Survey, the Brazilian branch of the World Mental Health Survey Initiative. Findings: 53.6% of the sample experienced at least one ECA, and parental death (16.1%) and physical abuse (16%) were the most reported occurrences. Parental mental illness (OR = 1.99 to 2.27) and family violence (OR = 1.55 to 1.99) were the adversities most consistently associated with psychopathology across all age groups, while economic adversities (OR = 2.71 to 3.30) and parent criminality (OR = 1.72 to 1.77) were associated with psychopathology in individuals whose onset of disorder occurred from age 13 years on. Parental mental disorders and economic adversities were the strongest and most consistent predictors of all four classes of psychopathologies examined in multivariate models controlled for the clustering of adversities. Physical abuse was associated with externalizing disorders, while sexual abuse with internalizing disorders. Interpretation: Childhood adversities were consistently associated with mental disorders. Economic adversities and parent mental disorders were predictive of psychopathology even if controlled for type (additive) and type and number of adversities (interactive models). Parental mental disorder and family violence were the main predictors of psychopathology onset across all age groups. Parental mental disorder was the only adversity that predicted all classes of disorders investigated.
- I don't need any treatment'' - barriers to mental health treatment in the general population of a megacity(2021) COELHO, Bruno M.; SANTANA, Geilson L.; VIANA, Maria C.; WANG, Yuan-Pang; ANDRADE, Laura H.Objective: Most countries fail to treat individuals with psychopathologies. Investigating treatment barriers and reasons for dropout are key elements to overcoming this scenario. Methods: A representative sample of 2,942 urban-dwelling adults was interviewed face-to-face within a cross-sectional, stratified, multistage probability survey of the general population. Psychiatric diagnosis, severity level, use of services, reasons for not seeking treatment, and treatment dropout were investigated. Results: Only 23% of individuals with a psychopathology of any severity level in the last 12 months received treatment. Low perceived need for treatment (56%) was the most common reason for not seeking treatment. The most visited settings were psychiatric, other mental health care, and general medical care. Among those with a perceived need for treatment (44%), psychological barriers were the most common reason for not seeking it. Treatment dropout was more prevalent among those who visited a general medical care setting. Among individuals still in treatment, human services and psychiatric care were the most common types. Female sex was associated with structural barriers (OR = 2.1). Disorder severity was negatively associated with need barriers (OR = 0.4), and positively associated with structural barriers (OR = 2.5) and psychological barriers (OR = 2.5). Conclusion: Despite the need for treatment and better services, psychological barriers were the major reason for not seeking treatment. Apart from providing more specialists, investing in awareness, de-stigmatization, and information is the ultimate strategy for improving psychiatric care.
- Gender-related patterns of psychiatric disorder clustering among bariatric surgery candidates: A latent class analysis(2018) DUARTE-GUERRA, Leorides Severo; COELHO, Bruno Mendonca; SANTO, Marco Aurelio; LOTUFO-NETO, Francisco; WANG, Yuan-PangBackground: Psychiatric disorders tend to distribute unevenly in women and men with severe obesity. The current research aimed to identify homogeneous clusters of concurrent psychiatric disorders among patients seeking bariatric surgery, by gender. Methods: We recruited a consecutive sample of 393 candidates with obesity (311 women and 82 men) in a university-based bariatric center. Trained clinicians assessed psychiatric disorders through the Structured Clinical Interview for DSM-IV (SCID). Latent class analysis categorized pre-surgical patients into uniform clusters of co-occurring psychiatric disorders. Results: For both genders, the 3-class psychopathological clustering was the best-fitting solution. Among women, the latent classes were: (1) ""oligosymptomatic"", wherein 42% of patients showed low probability of psychiatric disorders; (2) ""bipolar with comorbidities"", in 33%; and (3) ""anxiety/depression"", in 25%. Among men, (1) ""bipolar with comorbidities"" was found in 47% of patients; (2) ""oligosymptomatic"", in 40%; and (3) ""anxiety/depression"", in 13%. For both genders, the probability of presenting eating disorders was higher in both ""bipolar"" and ""anxiety/depression"" classes. Substance use disorders was prominent among ""bipolar"" men. In comparison with ""oligosymptomatic"" class, the likelihood of higher BMI was observed among ""bipolar"" men and poorer work attainment among men with ""anxiety/depression"". Limitation: Participants was cross-sectionally drawn from a single bariatric center. Conclusions: Pre-surgical men and women with severe obesity were distributed in three comorbidity profiles and revealed analogous psychopathological patterns. The class of ""bipolar disorders"" most likely presented comorbidity with eating and substance use disorder. This natural clustering of psychiatric disorders among bariatric patients suggests gender-related therapeutic approaches and surgical outcomes.
- Gender-related dimensions of childhood adversities in the general population(2018) COELHO, Bruno M.; SANTANA, Geilson L.; VIANA, Maria C.; ANDRADE, Laura H.; WANG, Yuan-PangObjective: Childhood adversities (CAs) comprise a group of negative experiences individuals may suffer in their lifetimes. The goal of the present study was to investigate the cluster discrimination of CAs through psychometric determination of the common attributes of such experiences for men and women. Methods: Parental mental illness, substance misuse, criminality, death, divorce, other parental loss, family violence, physical abuse, sexual abuse, neglect, physical illness, and economic adversity were assessed in a general-population sample (n=5,037). Exploratory and confirmatory factor analysis determined gender-related dimensions of CA. The contribution of each individual adversity was explored through Rasch analysis. Results: Adversities were reported by 53.6% of the sample. A three-factor model of CA dimensions fit the data better for men, and a two-factor model for women. For both genders, the dimension of family maladjustment - encompassing physical abuse, neglect, parental mental disorders, and family violence - was the core cluster of CAs. Women endorsed more CAs than men. Rasch analysis found that sexual abuse, physical illness, parental criminal behavior, parental divorce, and economic adversity were difficult to report in face-to-face interviews. Conclusion: CAs embrace sensitive personal information, clustering of which differed by gender. Acknowledging CAs may have an impact on medical and psychiatric outcomes in adulthood.