LAURA HELENA SILVEIRA GUERRA DE ANDRADE
Projetos de Pesquisa
Unidades Organizacionais
Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/23 - Laboratório de Psicopatologia e Terapêutica Psiquiátrica, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/23 - Laboratório de Psicopatologia e Terapêutica Psiquiátrica, Hospital das Clínicas, Faculdade de Medicina - Líder
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- Prevalence and Correlates of Bipolar Spectrum Disorder in the World Mental Health Survey Initiative(2011) MERIKANGAS, Kathleen R.; JIN, Robert; HE, Jian-Ping; KESSLER, Ronald C.; LEE, Sing; SAMPSON, Nancy A.; VIANA, Maria Carmen; ANDRADE, Laura Helena; HU, Chiyi; KARAM, Elie G.; LADEA, Maria; MEDINA-MORA, Maria Elena; ONO, Yutaka; POSADA-VILLA, Jose; SAGAR, Rajesh; WELLS, J. Elisabeth; ZARKOV, ZahariContext: There is limited information on the prevalence and correlates of bipolar spectrum disorder in international population-based studies using common methods. Objectives: To describe the prevalence, impact, patterns of comorbidity, and patterns of service utilization for bipolar spectrum disorder (BPS) in the World Health Organization World Mental Health Survey Initiative. Design, Setting, and Participants: Crosssectional, face-to-face, household surveys of 61 392 community adults in 11 countries in the Americas, Europe, and Asia assessed with the World Mental Health version of the World Health Organization Composite International Diagnostic Interview, version 3.0, a fully structured, lay-administered psychiatric diagnostic interview. Main Outcome Measures: Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) disorders, severity, and treatment. Results: The aggregate lifetime prevalences were 0.6% for bipolar type I disorder (BP-I), 0.4% for BP-II, 1.4% for subthreshold BP, and 2.4% for BPS. Twelve-month prevalences were 0.4% for BP-I, 0.3% for BP-II, 0.8% for subthreshold BP, and 1.5% for BPS. Severity of both manic and depressive symptoms as well as suicidal behavior increased monotonically from subthreshold BP to BP-I. By contrast, role impairment was similar across BP subtypes. Symptom severity was greater for depressive episodes than manic episodes, with approximately 74.0% of respondents with depression and 50.9% of respondents with mania reporting severe role impairment. Three-quarters of those with BPS met criteria for at least 1 other disorder, with anxiety disorders (particularly panic attacks) being the most common comorbid condition. Less than half of those with lifetime BPS received mental health treatment, particularly in low-income countries, where only 25.2% reported contact with the mental health system. Conclusions: Despite cross-site variation in the prevalence rates of BPS, the severity, impact, and patterns of comorbidity were remarkably similar internationally. The uniform increases in clinical correlates, suicidal behavior, and comorbidity across each diagnostic category provide evidence for the validity of the concept of BPS. Treatment needs for BPS are often unmet, particularly in low-income countries.
bookPart Diagnóstico em psiquiatria: desde os primórdios até as classificações contemporâneas(2021) WANG, Yuan-Pang; SANTANA, Geilson Lima; CôELHO, Bruno Mendonça; ANDRADE, Laura Helena Silveira Guerra de- Dual burden of chronic physical diseases and anxiety/mood disorders among Sao Paulo Megacity Mental Health Survey Sample, Brazil(2017) ASKARI, Melanie S.; ANDRADE, Laura Helena; FILHO, Alexandre Chiavegatto; SILVEIRA, Camila Magalhaes; SIU, Erica; WANG, Yuan-Pang; VIANA, Maria Carmen; MARTINS, Silvia S.Background: We assessed comorbid associations of 12-month DSM-IV mood/any anxiety disorders with chronic physical conditions within the Sao Paulo (SP) Megacity Mental Health cross-sectional survey of 5037 participants and explored whether strength of comorbid associations were modified when controlling for demographics. Methods: Chi-square tests and logistic regressions were used to examine comorbid associations of DSM-IV mood/anxiety disorders as measured by the WHO Composite International Diagnostic Interview (CIDI 3.0), and self-reported chronic physical conditions among adults from the SP Megacity Mental Health Survey. Results: Among those with any mood or anxiety disorder, chronic pain disorder was the most common physical condition (48.9% and 44.9%, respectively). Significant unadjusted odds ratios (OR) of comorbidity were found between diagnosis of two or more physical conditions and any mood disorders (3.08, 95% CI: 2.27-4.17), and any anxiety disorders (2.49, 95% CI: 1.95-3.17). Comorbidities remained significant when stratified by gender and controlling for marital status, household income, and education (latter two only included within anxiety models). Limitations: These results cannot be generalized to other cities or rural populations. Homeless and institutionalized populations were not surveyed. Due to cross-sectional study design, the direction of association between chronic disease/chronic disease risk factors and mood disorders is unclear. Conclusions: Dual burden of chronic physical conditions and mood/anxiety disorders is a notable problem among the Sao Paulo Megacity Survey population, with enhanced comorbidity experienced by community members with multiple physical conditions. Clinicians should consider these findings in understanding healthcare delivery for individuals suffering from both psychiatric disorders and chronic physical conditions.
article 5 Citação(ões) na Scopus Estimating Service Needs for Alcohol and Other Drug Users According to a Tiered Framework: The Case of the Sao Paulo, Brazil, Metropolitan Area(2019) MOTA, Daniela Cristina Belchior; SILVEIRA, Camila Magalhaes; SIU, Erica; GOMIDE, Henrique Pinto; GUERRA, Laura Helena Andrade; RONZANI, Telmo Mota; RUSH, BrianObjective: The purpose of this study was to estimate the need for population-level services for alcohol and other drug abuse in support of local planning. Method: Data were drawn from a subsample of 2,942 interviewees from the Sao Paulo Megacity Study, which evaluated mental health in the general population (18 years and older) of residents in the Sao Paulo metropolitan area. This population was classified into five hierarchical categories of severity, making it possible to obtain estimates of need for services, combining evaluation criteria regarding drug and alcohol use and general and mental health comorbidities over the last 12 months. For the at-risk groups in this population, estimates from the Potential Demand for the Use of Services survey interviews over the last year were generated. Results: Concerning the need for services, 86.5% of the population (Tier 1) had no problems related to drug and alcohol use, 8.9% (Tier 2) used heavily, 3.5% (Tiers 3, 4, and 5) met criteria for substance abuse disorders, among whom 1.3% (Tiers 4 and 5) require more specialized and intensive treatment and support. The following estimates for the Potential Demand for the Use of Services were found: 25.5% (Tier 3) and 51.1% (Tier 4), indicating that a significant number of individuals met criteria for substance abuse disorders but did not perceive any need for professional help or neglected the help available. Conclusions: In Sao Paulo there exists a large sector of the population that requires prevention strategies regarding the risks and harm resulting from alcohol and drug use, followed by a group requiring more specialized care. But a large number of substance users requiring specialized support did not use services and did not believe that they needed professional help.- Pediatric-Onset and Adult-Onset Separation Anxiety Disorder Across Countries in the World Mental Health Survey(2015) SILOVE, Derrick; ALONSO, Jordi; BROMET, Evelyn; GRUBER, Mike; SAMPSON, Nancy; SCOTT, Kate; ANDRADE, Laura; BENJET, Corina; ALMEIDA, Jose Miguel Caldas de; GIROLAMO, Giovanni De; JONGE, Peter de; DEMYTTENAERE, Koen; FIESTAS, Fabian; FLORESCU, Silvia; GUREJE, Oye; HE, Yanling; KARAM, Elie; LEPINE, Jean-Pierre; MURPHY, Sam; VILLA-POSADA, Jose; ZARKOV, Zahari; KESSLER, Ronald C.Objective: The age-at-onset criterion for separation anxiety disorder was removed in DSM-5, making it timely to examine the epidemiology of separation anxiety disorder as a disorder with onsets spanning the life course, using cross-country data. Method: The sample included 38,993 adults in 18 countries in the World Health Organization (WHO) World Mental Health Surveys. The WHO Composite International Diagnostic Interview was used to assess a range of DSM-IV disorders that included an expanded definition of separation anxiety disorder allowing onsets in adulthood. Analyses focused on prevalence, age at onset, comorbidity, predictors of onset and persistence, and separation anxiety-related role impairment. Results: Lifetime separation anxiety disorder prevalence averaged 4.8% across countries (interquartile range [25th-75th percentiles]=1.4%-6.4%), with 43.1% of lifetime onsets occurring after age 18. Significant time-lagged associations were found between earlier separation anxiety disorder and subsequent onset of internalizing and externalizing DSM-IV disorders and conversely between these disorders and subsequent onset of separation anxiety disorder. Other consistently significant predictors of lifetime separation anxiety disorder included female gender, retrospectively reported childhood adversities, and lifetime traumatic events. These predictors were largely comparable for separation anxiety disorder onsets in childhood, adolescence, and adulthood and across country income groups. Twelve-month separation anxiety disorder prevalence was considerably lower than lifetime prevalence (1.0% of the total sample: interquartile range=0.2%-1.2%). Severe separation anxiety-related 12-month role impairment was significantly more common in the presence (42.4%) than absence (18.3%) of 12-month comorbidity. Conclusions: Separation anxiety disorder is a common and highly comorbid disorder that can have onset across the lifespan. Childhood adversity and lifetime trauma are important antecedents, and adverse effects on role function make it a significant target for treatment.
- Twelve-month mental health service use in six countries of the Americas: A regional report from the World Mental Health Surveys(2020) BORGES, G.; AGUILAR-GAXIOLA, S.; ANDRADE, L.; BENJET, C.; CIA, A.; KESSLER, R. C.; OROZCO, R.; SAMPSON, N.; STAGNARO, J. C.; TORRES, Y.; VIANA, Maria Carmen; MEDINA-MORA, M. E.Aims. To provide cross-national data for selected countries of the Americas on service utilization for psychiatric and substance use disorders, the distribution of these services among treatment sectors, treatment adequacy and factors associated with mental health treatment and adequacy of treatment. Methods. Data come from data collected from 6710 adults with 12 month mental disorder surveys across seven surveys in six countries in North (USA), Central (Mexico) and South (Argentina, Brazil, Colombia, Peru) America who were interviewed 2001-2015 as part of the World Health Organization (WHO) World Mental Health (WMH) Surveys. DSM-IV diagnoses were made with the WHO Composite International Diagnostic Interview (CIDI). Interviews also assessed service utilization by the treatment sector, adequacy of treatment received and socio-demographic correlates of treatment. Results. Little over one in four of respondents with any 12 month DSM-IV/CIDI disorder received any treatment. Although the vast majority (87.1%) of this treatment was minimally adequate, only 35.3% of cases received treatment that met acceptable quality guidelines. Indicators of social-advantage (high education and income) were associated with higher rates of service use and adequacy, but a number of other correlates varied across survey sites. Conclusions. These results shed light on an enormous public health problem involving under-treatment of common mental disorders, although the problem is most extreme among people with social disadvantage. Promoting services that are more accessible, especially for those with few resources, is urgently needed.
- Undertreatment of people with major depressive disorder in 21 countries(2017) THORNICROFT, Graham; CHATTERJI, Somnath; EVANS-LACKO, Sara; GRUBER, Michael; SAMPSON, Nancy; AGUILAR-GAXIOLA, Sergio; AL-HAMZAWI, Ali; ALONSO, Jordi; ANDRADE, Laura; BORGES, Guilherme; BRUFFAERTS, Ronny; BUNTING, Brendan; ALMEIDA, Jose Miguel Caldas de; FLORESCU, Silvia; GIROLAMO, Giovanni de; GUREJE, Oye; HARO, Josep Maria; HE, Yanling; HINKOV, Hristo; KARAM, Elie; KAWAKAMI, Norito; LEE, Sing; NAVARRO-MATEU, Fernando; PIAZZA, Marina; POSADA-VILLA, Jose; GALVIS, Yolanda Torres de; KESSLER, Ronald C.Background Major depressive disorder (MDD) is a leading cause of disability worldwide. Aims To examine the: (a) 12-month prevalence of DSM-IV MDD; (b) proportion aware that they have a problem needing treatment and who want care; (c) proportion of the latter receiving treatment; and (d) proportion of such treatment meeting minimal standards. Method Representative community household surveys from 21 countries as part of the World Health Organization World Mental Health Surveys. Results Of 51 547 respondents, 4.6% met 12-month criteria for DSM-IV MDD and of these 56.7% reported needing treatment. Among those who recognised their need for treatment, most (71.1%) made at least one visit to a service provider. Among those who received treatment, only 41.0% received treatment that met minimal standards. This resulted in only 16.5% of all individuals with 12-month MDD receiving minimally adequate treatment. Conclusions Only a minority of participants with MDD received minimally adequate treatment: 1 in 5 people in high-income and 1 in 27 in low-/lower-middle-income countries. Scaling up care for MDD requires fundamental transformations in community education and outreach, supply of treatment and quality of services.
article Changes needed in the classification of depressive disorders: options for ICD-11(2012) PAYKEL, Eugene; ANDRADE, Laura H.; NJENGA, Frank; PHILLIPS, Michael R.This paper considers changes required to the classification of non-bipolar depressive disorders in ICD-11, using ICD-10 as a starting point. The new classification needs to recognize recent epidemiological findings, cross-cultural variations in presentation of depression and differences in provision of health care among WHO Member States. Recommended changes in organization include making the main distinction between bipolar and unipolar disorders, and use of only one overall depressive episode diagnosis, with the distinction between first and recurrent episode to become a subtype or be abandoned. Some redrafting of the criteria for depressive episode is suggested, in order to simplify. Subtypes are discussed, with possible addition of two subtypes (seasonal affective disorder and postpartum depression) and an improved way of handling mixed anxiety-depressive disorders.article Somatization in Latin America: a review on the classification of somatoform disorders, functional syndromes, and medically unexplained symptoms(2011) TOFOLI, Luis Fernando; ANDRADE, Laura Helena; FORTES, SandraObjective: medically unexplained symptoms are common and associated with mental illness in various contexts. Previous studies show that Latin American populations are prone to somatization. Given the reformulation of the International Classification of Diseases towards its 11(th) edition the peculiarities of the population from this region of the world shall be taken into consideration. The objective of this study is to provide information on somatization in Latin American populations to help the decision making about medically unexplained symptoms diagnostic categories in the 11(th) edition of the International Classification of Diseases. Method: Extensive review of the academic production from 1995 to 2011 on somatization in populations of Latin American origin. Results: The analysis of 106 studies included in this review was divided into 15 categories: systematic reviews, conceptual reviews, prevalence, primary care, depression and anxiety, risk factors, violence, organic conditions, relationship with health care, ethnicity, culture-bound syndromes, chronic fatigue syndrome, fibromyalgia, body dysmorphic disorder, and conversion and dissociation. Conclusion: The Latin American studies confirm the difficulty in defining medically unexplained symptoms categories. The supposed ""somatizing trace"" of Latin cultures may be linked more to cultural and linguistic expression than to an ethnic nature, and these peculiarities must be on the agenda for the new classification of these phenomena in the Classification of Diseases-11th edition.- Drinking Patterns and Alcohol Use Disorders in Sao Paulo, Brazil: The Role of Neighborhood Social Deprivation and Socioeconomic Status(2014) SILVEIRA, Camila Magalhaes; SIU, Erica Rosanna; ANTHONY, James C.; SAITO, Luis Paulo; ANDRADE, Arthur Guerra de; KUTSCHENKO, Andressa; VIANA, Maria Carmen; WANG, Yuan-Pang; MARTINS, Silvia S.; ANDRADE, Laura HelenaBackground: Research conducted in high-income countries has investigated influences of socioeconomic inequalities on drinking outcomes such as alcohol use disorders (AUD), however, associations between area-level neighborhood social deprivation (NSD) and individual socioeconomic status with these outcomes have not been explored in Brazil. Thus, we investigated the role of these factors on drink-related outcomes in a Brazilian population, attending to male-female variations. Methods: A multi-stage area probability sample of adult household residents in the Sao Paulo Metropolitan Area was assessed using the WHO Composite International Diagnostic Interview (WMH-CIDI) (n = 5,037). Estimation focused on prevalence and correlates of past-year alcohol disturbances [heavy drinking of lower frequency (HDLF), heavy drinking of higher frequency (HDHF), abuse, dependence, and DMS-5 AUD] among regular users (RU); odds ratio (OR) were obtained. Results: Higher NSD, measured as an area-level variable with individual level variables held constant, showed an excess odds for most alcohol disturbances analyzed. Prevalence estimates for HDLF and HDHF among RU were 9% and 20%, respectively, with excess odds in higher NSD areas; schooling (inverse association) and low income were associated with male HDLF. The only individual-level association with female HDLF involved employment status. Prevalence estimates for abuse, dependence, and DSM-5 AUD among RU were 8%, 4%, and 8%, respectively, with excess odds of: dependence in higher NSD areas for males; abuse and AUD for females. Among RU, AUD was associated with unemployment, and low education with dependence and AUD. Conclusions: Regular alcohol users with alcohol-related disturbances are more likely to be found where area-level neighborhood characteristics reflect social disadvantage. Although we cannot draw inferences about causal influence, the associations are strong enough to warrant future longitudinal alcohol studies to explore causal mechanisms related to the heterogeneous patterns of association and male-female variations observed herein. Hopefully, these findings may help guide future directions for public health.