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.
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.- The psychosis continuum in the general population: findings from the Sao Paulo Epidemiologic Catchment Area Study(2011) LOCH, Alexandre Andrade; WANG, Yuan-Pang; ROESSLER, Wulf; TOFOLI, Luis Fernando; SILVEIRA, Camila Magalhaes; ANDRADE, Laura HelenaThe aim of the study was to examine the psychosis continuum in a Latin-American community setting. Data were from the Brazilian Sao Paulo Epidemiologic Catchment Area Study, a cross-sectional survey conducted in two boroughs of the city of Sao Paulo. The Composite International Diagnosis Interview (version 1.1) was applied to a probabilistic sample of 1,464 adults, who were interviewed in their household, in order to identify the presence of psychotic symptoms. A subsample was assessed with Schedules for Clinical Assessment in Neuropsychiatry interview. We described the occurrence of psychotic symptoms, categorized into subgroups according to their clinical impact, disability, and help-seeking behavior. The correlation of socio-demographic variables, depressive symptoms, and alcohol and substance use disorders with those psychotic subgroups was analyzed. Polychotomic logistic regression tested the associations between subgroups of psychosis (clinical and subclinical) and the correlates. Of the total sample, 38.0% presented at least one lifetime psychotic symptom, 1.9% met the criteria for an ICD-10 diagnosis of non-affective psychosis, 5.4% presented clinically relevant psychotic symptoms, and 30.7% endorsed clinically non-relevant symptoms. The most common psychotic symptom was delusion with a plausible explanation (in 18.6%). The presence of any psychiatric diagnosis was associated with the presence of psychotic symptoms (OR range, 1.9-8.9). Subclinical psychosis subgroups were found to be associated with the 18-24 year age bracket, chronic depressive mood, and alcohol use disorder. Our results support the concept of a psychosis continuum in Latin-American populations, suggesting that different risk factors influence their manifestation across the continuum.
- Parental psychopathology and the risk of suicidal behavior in their offspring: results from the World Mental Health surveys(2011) GUREJE, O.; OLADEJI, B.; HWANG, I.; CHIU, W. T.; KESSLER, R. C.; SAMPSON, N. A.; ALONSO, J.; ANDRADE, L. H.; BEAUTRAIS, A.; BORGES, G.; BROMET, E.; BRUFFAERTS, R.; GIROLAMO, G. de; GRAAF, R. de; GAL, G.; HE, Y.; HU, C.; IWATA, N.; KARAM, E. G.; KOVESS-MASFETY, V.; MATSCHINGER, H.; MOLDOVAN, M. V.; POSADA-VILLA, J.; SAGAR, R.; SCOCCO, P.; SEEDAT, S.; TOMOV, T.; NOCK, M. K.Previous research suggests that parental psychopathology predicts suicidal behavior among offspring; however, the more fine-grained associations between specific parental disorders and distinct stages of the pathway to suicide are not well understood. We set out to test the hypothesis that parental disorders associated with negative mood would predict offspring suicide ideation, whereas disorders characterized by impulsive aggression (for example, antisocial personality) and anxiety/agitation (for example, panic disorder) would predict which offspring act on their suicide ideation and make a suicide attempt. Data were collected during face-to-face interviews conducted on nationally representative samples (N=55 299; age 18+) from 21 countries around the world. We tested the associations between a range of parental disorders and the onset and persistence over time (that is, time since most recent episode controlling for age of onset and time since onset) of subsequent suicidal behavior (suicide ideation, plans and attempts) among offspring. Analyses tested bivariate and multivariate associations between each parental disorder and distinct forms of suicidal behavior. Results revealed that each parental disorder examined increased the risk of suicide ideation among offspring, parental generalized anxiety and depression emerged as the only predictors of the onset and persistence (respectively) of suicide plans among offspring with ideation, whereas parental antisocial personality and anxiety disorders emerged as the only predictors of the onset and persistence of suicide attempts among ideators. A dose-response relation between parental disorders and respondent risk of suicide ideation and attempt was also found. Parental death by suicide was a particularly strong predictor of persistence of suicide attempts among offspring. These associations remained significant after controlling for comorbidity of parental disorders and for the presence of mental disorders among offspring. These findings should inform future explorations of the mechanisms of intergenerational transmission of suicidal behavior. Molecular Psychiatry (2011) 16, 1221-1233; doi:10.1038/mp.2010.111; published online 16 November 2010
- Psychiatry - life events and social support in late life depression(2011) ALEXANDRINO-SILVA, Clovis; ALVES, Tania Ferraz; TOFOLI, Luis Fernando; WANG, Yuan-Pang; ANDRADE, Laura HelenaOBJECTIVES: To examine the association of life events and social support in the broadly defined category of depression in late life. INTRODUCTION: Negative life events and lack of social support are associated with depression in the elderly. Currently, there are limited studies examining the association between life events, social support and late-life depression in Brazil. METHODS: We estimated the frequency of late-life depression within a household community sample of 367 subjects aged 60 years or greater with associated factors. ""Old age symptomatic depression'' was defined using the Composite International Diagnostic Interview 1.1 tool. This diagnostic category included only late-life symptoms and consisted of the diagnoses of depression and dysthymia as well as a subsyndromal definition of depression, termed ""late subthreshold depression''. Social support and life events were assessed using the Comprehensive Assessment and Referral Evaluation (SHORT-CARE) inventory. RESULTS: ""Old age symptomatic depression'' occurred in 18.8% of the patients in the tested sample. In univariate analyses, this condition was associated with female gender, lifetime anxiety disorder and living alone. In multivariate models, ""old age symptomatic depression'' was associated with a perceived lack of social support in men and life events in women. DISCUSSION: Social support and life events were determined to be associated with late-life depression, but it is important to keep in mind the differences between genders. Also, further exploration of the role of lifetime anxiety disorder in late-life depression may be of future importance. CONCLUSIONS: We believe that this study helps to provide insight into the role of psychosocial factors in late-life depression.
- Cross-national epidemiology of DSM-IV major depressive episode(2011) BROMET, Evelyn; ANDRADE, Laura Helena; HWANG, Irving; SAMPSON, Nancy A.; ALONSO, Jordi; GIROLAMO, Giovanni de; GRAAF, Ron de; DEMYTTENAERE, Koen; HU, Chiyi; IWATA, Noboru; KARAM, Aimee N.; KAUR, Jagdish; KOSTYUCHENKO, Stanislav; LEPINE, Jean-Pierre; LEVINSON, Daphna; MATSCHINGER, Herbert; MORA, Maria Elena Medina; BROWNE, Mark Oakley; POSADA-VILLA, Jose; VIANA, Maria Carmen; WILLIAMS, David R.; KESSLER, Ronald C.Background: Major depression is one of the leading causes of disability worldwide, yet epidemiologic data are not available for many countries, particularly low- to middle-income countries. In this paper, we present data on the prevalence, impairment and demographic correlates of depression from 18 high and low-to middle-income countries in the World Mental Health Survey Initiative. Methods: Major depressive episodes (MDE) as defined by the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DMS-IV) were evaluated in face-to-face interviews using the World Health Organization Composite International Diagnostic Interview (CIDI). Data from 18 countries were analyzed in this report (n = 89,037). All countries surveyed representative, population-based samples of adults. Results: The average lifetime and 12-month prevalence estimates of DSM-IV MDE were 14.6% and 5.5% in the ten high-income and 11.1% and 5.9% in the eight low- to middle-income countries. The average age of onset ascertained retrospectively was 25.7 in the high-income and 24.0 in low- to middle-income countries. Functional impairment was associated with recency of MDE. The female: male ratio was about 2: 1. In high-income countries, younger age was associated with higher 12-month prevalence; by contrast, in several low-to middle-income countries, older age was associated with greater likelihood of MDE. The strongest demographic correlate in high-income countries was being separated from a partner, and in low- to middle-income countries, was being divorced or widowed. Conclusions: MDE is a significant public-health concern across all regions of the world and is strongly linked to social conditions. Future research is needed to investigate the combination of demographic risk factors that are most strongly associated with MDE in the specific countries included in the WMH.
- Premarital mental disorders and physical violence in marriage: cross-national study of married couples(2011) MILLER, E.; BRESLAU, J.; PETUKHOVA, M.; FAYYAD, J.; GREEN, J. Greif; KOLA, L.; SEEDAT, S.; STEIN, D. J.; TSANG, A.; VIANA, M. C.; ANDRADE, L. H.; DEMYTTENAERE, K.; GIROLAMO, G. de; HARO, J. M.; HU, C.; KARAM, E. G.; KOVESS-MASFETY, V.; TOMOV, T.; KESSLER, R. C.Backgroud Mental disorders may increase the risk of physical violence among married couples. Aims To estimate associations between premarital mental disorders and marital violence in a cross-national sample of married couples. Method A total of 1821 married couples (3642 individuals) from 11 countries were interviewed as part of the World Health Organization's World Mental Health Survey Initiative. Sixteen mental disorders with onset prior to marriage were examined as predictors of marital violence reported by either spouse. Results Any physical violence was reported by one or both spouses in 20% of couples, and was associated with husbands' externalising disorders (OR = 1.7, 95% Cl 1.2-2.3). Overall, the population attributable risk for marital violence related to premarital mental disorders was estimated to be 17.2%. Conclusions Husbands' externalising disorders had a modest but consistent association with marital violence across diverse countries. This finding has implications for the development of targeted interventions to reduce risk of marital violence.
- A multinational study of mental disorders, marriage, and divorce(2011) BRESLAU, J.; MILLER, E.; JIN, R.; SAMPSON, N. A.; ALONSO, J.; ANDRADE, L. H.; BROMET, E. J.; GIROLAMO, G. de; DEMYTTENAERE, K.; FAYYAD, J.; FUKAO, A.; GALAON, M.; GUREJE, O.; HE, Y.; HINKOV, H. R.; HU, C.; KOVESS-MASFETY, V.; MATSCHINGER, H.; MEDINA-MORA, M. E.; ORMEL, J.; POSADA-VILLA, J.; SAGAR, R.; SCOTT, K. M.; KESSLER, R. C.Objective: Estimate predictive associations of mental disorders with marriage and divorce in a cross-national sample. Method: Population surveys of mental disorders included assessment of age at first marriage in 19 countries (n = 46 128) and age at first divorce in a subset of 12 countries (n = 30 729). Associations between mental disorders and subsequent marriage and divorce were estimated in discrete time survival models. Results: Fourteen of 18 premarital mental disorders are associated with lower likelihood of ever marrying (odds ratios ranging from 0.6 to 0.9), but these associations vary across ages of marriage. Associations between premarital mental disorders and marriage are generally null for early marriage (age 17 or younger), but negative associations come to predominate at later ages. All 18 mental disorders are positively associated with divorce (odds ratios ranging from 1.2 to 1.8). Three disorders, specific phobia, major depression, and alcohol abuse, are associated with the largest population attributable risk proportions for both marriage and divorce. Conclusion: This evidence adds to research demonstrating adverse effects of mental disorders on life course altering events across a diverse range of socioeconomic and cultural settings. These effects should be included in considerations of public health investments in preventing and treating mental disorders.
- Development of Lifetime Comorbidity in the World Health Organization World Mental Health Surveys(2011) KESSLER, Ronald C.; ORMEL, Johan; PETUKHOVA, Maria; MCLAUGHLIN, Katie A.; GREEN, Jennifer Greif; RUSSO, Leo J.; STEIN, Dan J.; ZASLAVSKY, Alan M.; AGUILAR-GAXIOLA, Sergio; ALONSO, Jordi; ANDRADE, Laura; BENJET, Corina; GIROLAMO, Giovanni de; GRAAF, Ron de; DEMYTTENAERE, Koen; FAYYAD, John; HARO, Josep Maria; HU, Chi Yi; KARAM, Aimee; LEE, Sing; LEPINE, Jean-Pierre; MATCHSINGER, Herbert; MIHAESCU-PINTIA, Constanta; POSADA-VILLA, Jose; SAGAR, Rajesh; UESTUEN, T. BedirhanContext: Although numerous studies have examined the role of latent variables in the structure of comorbidity among mental disorders, none has examined their role in the development of comorbidity. Objective: To study the role of latent variables in the development of comorbidity among 18 lifetime DSM-IV disorders in the World Health Organization World Mental Health Surveys. Design: Nationally or regionally representative community surveys. Setting: Fourteen countries. Participants: A total of 21 229 survey respondents. Main Outcome Measures: First onset of 18 lifetime DSM-IV anxiety, mood, behavior, and substance disorders assessed retrospectively in the World Health Organization Composite International Diagnostic Interview. Results: Separate internalizing (anxiety and mood disorders) and externalizing (behavior and substance disorders) factors were found in exploratory factor analysis of lifetime disorders. Consistently significant positive time-lagged associations were found in survival analyses for virtually all temporally primary lifetime disorders predicting subsequent onset of other disorders. Within-domain (ie, internalizing or externalizing) associations were generally stronger than between-domain associations. Most time-lagged associations were explained by a model that assumed the existence of mediating latent internalizing and externalizing variables. Specific phobia and obsessive-compulsive disorder (internalizing) and hyperactivity and oppositional defiant disorders (externalizing) were the most important predictors. A small number of residual associations remained significant after controlling the latent variables. Conclusions: The good fit of the latent variable model suggests that common causal pathways account for most of the comorbidity among the disorders considered herein. These common pathways should be the focus of future research on the development of comorbidity, although several important pairwise associations that cannot be accounted for by latent variables also exist that warrant further focused study.
- Sociodemographic Correlates of Transitions from Alcohol Use to Disorders and Remission in the Sao Paulo Megacity Mental Health Survey, Brazil(2011) SILVEIRA, Camila Magalhaes; VIANA, Maria Carmen; SIU, Erica Rosanna; ANDRADE, Arthur Guerra de; ANTHONY, James C.; ANDRADE, Laura HelenaAims: To evaluate sociodemographic correlates associated with transitions from alcohol use to disorders and remission in a Brazilian population. Methods: Data are from a probabilistic, multi-stage clustered sample of adult household residents in the Sao Paulo Metropolitan Area. Alcohol use, regular use (at least 12 drinks/year), DSM-IV abuse and dependence and remission from alcohol use disorders (AUDs) were assessed with the World Mental Health version of the Composite International Diagnostic Interview. Age of onset (AOO) distributions of the cumulative lifetime probability of each alcohol use stage were prepared with data obtained from 5037 subjects. Correlates of transitions were obtained from a subsample of 2942 respondents, whose time-dependent sociodemographic data were available. Results: Lifetime prevalences were 85.8% for alcohol use, 56.2% for regular use, 10.6% for abuse and 3.6% for dependence; 73.4 and 58.8% of respondents with lifetime abuse and dependence, respectively, had remitted. The number of sociodemographic correlates decreased from alcohol use to disorders. All transitions across alcohol use stages up to abuse were consistently associated with male gender, younger cohorts and lower education. Importantly, low education was a correlate for developing AUD and not remitting from dependence. Early AOO of first alcohol use was associated with the transition of regular use to abuse. Conclusion: The present study demonstrates that specific correlates differently contribute throughout alcohol use trajectory in a Brazilian population. It also reinforces the need of preventive programs focused on early initiation of alcohol use and high-risk individuals, in order to minimize the progression to dependence and improve remission from AUD.