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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- Disability Mediates the Impact of Common Conditions on Perceived Health(2013) ALONSO, Jordi; VILAGUT, Gemma; ADROHER, Nuria D.; CHATTERJI, Somnath; HE, Yanling; ANDRADE, Laura Helena; BROMET, Evelyn; BRUFFAERTS, Ronny; FAYYAD, John; FLORESCU, Silvia; GIROLAMO, Giovanni de; GUREJE, Oye; HARO, Josep Maria; HINKOV, Hristo; HU, Chiyi; IWATA, Noboru; LEE, Sing; LEVINSON, Daphna; LEPINE, Jean Pierre; MATSCHINGER, Herbert; MEDINA-MORA, Maria Elena; O'NEILL, Siobhan; HORMEL, J.; POSADA-VILLA, Jose A.; TAIB, Nezar Ismet; XAVIER, Miguel; KESSLER, Ronald C.Background: We examined the extent to which disability mediates the observed associations of common mental and physical conditions with perceived health. Methods and Findings: WHO World Mental Health (WMH) Surveys carried out in 22 countries worldwide (n = 51,344 respondents, 72.0% response rate). We assessed nine common mental conditions with the WHO Composite International Diagnostic Interview (CIDI), and ten chronic physical with a checklist. A visual analog scale (VAS) score (0, worst to 100, best) measured perceived health in the previous 30 days. Disability was assessed using a modified WHO Disability Assessment Schedule (WHODAS), including: cognition, mobility, self-care, getting along, role functioning (life activities), family burden, stigma, and discrimination. Path analysis was used to estimate total effects of conditions on perceived health VAS and their separate direct and indirect (through the WHODAS dimensions) effects. Twelve-month prevalence was 14.4% for any mental and 51.4% for any physical condition. 31.7% of respondents reported difficulties in role functioning, 11.4% in mobility, 8.3% in stigma, 8.1% in family burden and 6.9% in cognition. Other difficulties were much less common. Mean VAS score was 81.0 (SD = 0.1). Decrements in VAS scores were highest for neurological conditions (9.8), depression (8.2) and bipolar disorder (8.1). Across conditions, 36.8% (IQR: 31.2-51.5%) of the total decrement in perceived health associated with the condition were mediated by WHODAS disabilities (significant for 17 of 19 conditions). Role functioning was the dominant mediator for both mental and physical conditions. Stigma and family burden were also important mediators for mental conditions, and mobility for physical conditions. Conclusions: More than a third of the decrement in perceived health associated with common conditions is mediated by disability. Although the decrement is similar for physical and mental conditions, the pattern of mediation is different. Research is needed on the benefits for perceived health of targeted interventions aimed at particular disability dimensions.
- Does income inequality get under the skin? A multilevel analysis of depression, anxiety and mental disorders in Sao Paulo, Brazil(2013) CHIAVEGATTO FILHO, Alexandre Dias Porto; KAWACHI, Ichiro; WANG, Yuan Pang; VIANA, Maria Carmen; ANDRADE, Laura Helena Silveira GuerraObjective Test the original income inequality theory, by analysing its association with depression, anxiety and any mental disorders. Methods We analysed a sample of 3542 individuals aged 18years and older selected through a stratified, multistage area probability sample of households from the SAo Paulo Metropolitan Area. Mental disorder symptoms were assessed using the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria. Bayesian multilevel logistic models were performed. Results Living in areas with medium and high-income inequality was statistically associated with increased risk of depression, relative to low-inequality areas (OR 1.76; 95% CI 1.21 to 2.55, and 1.53; 95% CI 1.07 to 2.19, respectively). The same was not true for anxiety (OR 1.25; 95% CI 0.90 to 1.73, and OR 1.07; 95% CI 0.79 to 1.46). In the case of any mental disorder, results were mixed. Conclusions In general, our findings were consistent with the income inequality theory, that is, people living in places with higher income inequality had an overall higher odd of mental disorders, albeit not always statistically significant. The fact that depression, but not anxiety, was statistically significant could indicate a pathway by which inequality influences health.
- DSM-V NICOTINE USE DISORDER SYMPTOM PROFILES IN A REPRESENTATIVE SAMPLE OF THE LARGEST METROPOLITAN AREA IN SOUTH AMERICA(2013) CASTALDELLI-MAIA, Joao Mauricio; ANDRADE, Laura Helena Guerra de; VIANA, Maria Carmen; ANDRADE, Arthur Guerra de; MARTINS, Silvia SaboiaAims: Given the development of a new diagnostic classification(DSM-V) for nicotine use disorders(NUD), we aimed to identify continuous and cathegorical fenotipes among indivuduals who had at least 1 cigarette per week during life-time. Most of the conceptual framework for NUD come only from alcohol use disorder(AUD) studies. Data came from São Paulo Megacity Project (SPM) collected between 2005-2007, which is part of World Mental Health Surveys. Methods: Exploratory factorial analysis(EFA) and latent class analysis(LCA) of the DSM-V NUD symptoms - SPM did not include the 3 DSM-IV nicotine abuse questions - were performed using Mplus software taking into account complex survey design features. Then, via weighted logistic regression models, we examined socio-demographic correlates of the DSM-V NUD latent classes. Results: As in DSM-VAUD studies, an one-factor model reached the best fitin EFA, including very high loadings(>60%) of all eight symptoms tested. The best LCA model was a four-class model: 1) a “non-symptomatic class”(31.1%), 2) a “lost control class” (27.3%) - defined by high probabilities of “use in larger amounts” and unable to cut down criteria-, 3) a “craving-tolerance class” (7.9%) and 4) a “high-symptomatic class” (33.6%). Those in the “lost-control class” and “craving tolerance class” were more than 2 times more likely to be 18-34 years-old than those in the non-symptomatic class. Being in the three symptomatic classes was associated with unemployment/other as compared being in the non-symptomatic class. Conclusion: Prevention and specific treatment protocol can be designed based on this data. Varenicline or bupropion, as anti-craving medications, seem to be an interesting treatment option for those in the “craving-tolerance class”. Cognitive-behavioral therapy(plus pharmacological treatment) are adequate for those in “loss-control class”. Unemployed and young adults could be the target of prevention interventions for NUD in Brazil.
- Cross-national differences in the prevalence and correlates of burden among older family caregivers in the World Health Organization World Mental Health (WMH) Surveys(2013) SHAHLY, V.; CHATTERJI, S.; GRUBER, M. J.; AL-HAMZAWI, A.; ALONSO, J.; ANDRADE, L. H.; ANGERMEYER, M. C.; BRUFFAERTS, R.; BUNTING, B.; CALDAS-DE-ALMEIDA, J. M.; GIROLAMO, G. de; JONGE, P. de; FLORESCU, S.; GUREJE, O.; HARO, J. M.; HINKOV, H. R.; HU, C.; KARAM, E. G.; LEPINE, J. -P.; LEVINSON, D.; MEDINA-MORA, M. E.; POSADA-VILLA, J.; SAMPSON, N. A.; TRIVEDI, J. K.; VIANA, M. C.; KESSLER, R. C.Background. Current trends in population aging affect both recipients and providers of informal family caregiving, as the pool of family caregivers is shrinking while demand is increasing. Epidemiological research has not yet examined the implications of these trends for burdens experienced by aging family caregivers. Method. Cross-sectional community surveys in 20 countries asked 13 892 respondents aged 50+ years about the objective (time, financial) and subjective (distress, embarrassment) burdens they experience in providing care to first-degree relatives with 12 broadly defined serious physical and mental conditions. Differential burden was examined by country income category, kinship status and type of condition. Results. Among the 26.9-42.5% respondents in high-, upper-middle-, and low-/lower-middle-income countries reporting serious relative health conditions, 35.7-42.5% reported burden. Of those, 25.2-29.0% spent time and 13.5-19.4% money, while 24.4-30.6% felt distress and 6.4-21.7% embarrassment. Mean caregiving hours per week in those giving any time were 16.6-23.6 (169.9-205.8 h/week per 100 people aged 50+ years). Burden in low-/lower-middle-income countries was 2- to 3-fold higher than in higher-income countries, with any financial burden averaging 14.3% of median family income in high-, 17.7% in upper-middle-, and 39.8% in low-/lower-middle-income countries. Higher burden was reported by women than men and for conditions of spouses and children than parents or siblings. Conclusions. Uncompensated family caregiving is an important societal asset that offsets rising formal healthcare costs. However, the substantial burdens experienced by aging caregivers across multiple family health conditions and geographic regions threaten the continued integrity of their caregiving capacity. Initiatives supporting older family caregivers are consequently needed, especially in low-/lower-middle-income countries.
- Childhood Adversity and Adult Onset of Hypertension and Heart Disease in Sao Paulo, Brazil(2013) PARRISH, Canada; SURKAN, Pamela J.; MARTINS, Silvia S.; GATTAZ, Wagner F.; ANDRADE, Laura Helena; VIANA, Maria CarmenUsing data from the Sao Paulo Megacity Mental Health Survey and logistic regression models, we studied how childhood neglect, physical abuse, sexual abuse, and family violence were related to adult hypertension and heart disease. After adjustment for sociodemographic factors, child physical abuse was associated with hypertension and heart disease, whereas family violence was associated with hypertension. Efforts to curb child physical abuse could potentially reduce subsequent hypertension and heart disease.
- Family burden related to mental and physical disorders in the world: results from the WHO World Mental Health (WMH) surveys(2013) VIANA, Maria Carmen; GRUBER, Michael J.; SHAHLY, Victoria; ALHAMZAWI, Ali; ALONSO, Jordi; ANDRADE, Laura H.; ANGERMEYER, Matthias C.; BENJET, Corina; BRUFFAERTS, Ronny; CALDAS-DE-ALMEIDA, Jose Miguel; GIROLAMO, Giovanni de; JONGE, Peter de; FERRY, Finola; FLORESCU, Silvia; GUREJE, Oye; HARO, Josep Maria; HINKOV, Hristo; HU, Chiyi; KARAM, Elie G.; LEPINE, Jean-Pierre; LEVINSON, Daphna; POSADA-VILLA, Jose; SAMPSON, Nancy A.; KESSLER, Ronald C.Objective: To assess prevalence and correlates of family caregiver burdens associated with mental and physical conditions worldwide. Methods: Cross-sectional community surveys asked 43,732 adults residing in 19 countries of the WHO World Mental Health (WMH) Surveys about chronic physical and mental health conditions of first-degree relatives and associated objective (time, financial) and subjective (distress, embarrassment) burdens. Magnitudes and associations of burden are examined by kinship status and family health problem; population-level estimates are provided. Results: Among the 18.9-40.3% of respondents in high, upper-middle, and low/lower-middle income countries with first-degree relatives having serious health problems, 39.0-39.6% reported burden. Among those, 22.9-31.1% devoted time, 10.6-18.8% had financial burden, 23.3-27.1% reported psychological distress, and 6.0-17.2% embarrassment. Mean caregiving hours/week was 12.9-16.5 (83.7-147.9 hours/week/100 people aged 18+). Mean financial burden was 15.1% of median family income in high, 32.2% in upper-middle, and 44.1% in low/lower-middle income countries. A higher burden was reported by women than men, and for care of parents, spouses, and children than siblings. Conclusions: The uncompensated labor of family caregivers is associated with substantial objective and subjective burden worldwide. Given the growing public health importance of the family caregiving system, it is vital to develop effective interventions that support family caregivers.
- Gender differences in symptomatic profiles of depression: Results from the Sao Paulo Megacity Mental Health Survey(2013) ALEXANDRINO-SILVA, Clovis; WANG, Yuan-Pang; VIANA, Maria Carmen; BULHOES, Rodrigo S.; MARTINS, Silvia S.; ANDRADE, Laura HelenaBackground: Few studies have investigated symptomatic subtypes of depression and their correlates by gender. Methods: Data are from the Sao Paulo Megacity Mental Health Survey. Symptom profiles of 1207 subjects (864 women; 343 men) based upon symptoms of the worst depressive episode in lifetime were examined through latent class analysis. Correlates of gender-specific latent classes were analyzed by logistic regression. Results: For both men and women, a 3-class model was the best solution. A mild class was found in both genders (41.1% in women; 40.1% in men). Gender differences appeared in the most symptomatic classes. In women, they were labeled melancholic (39.3%) and atypical (19.5%), differing among each other in somatic/vegetative symptoms. The melancholic class presented inhibition and eating/sleeping symptoms in the direction of decreasing, whereas the atypical class had increased appetite/weight, and hypersomnia. For men, symptoms that differentiate the two most symptomatic classes were related to psychomotor activity: a melancholic/psychomotor retarded (40.4%) and agitated depression (19.6%). The highest between-class proportion of agitation and racing thoughts was found among men in the agitated class, with similarity to bipolar mixed state. Limitations: Analyses were restricted to those who endorsed questions about their worst lifetime depressive episode; the standardized assessment by lay interviewers; the small male sample size. Conclusions: The construct of depression of current classifications is heterogeneous at the symptom level, where gender different subtypes can be identified. These symptom profiles have potential implications for the nosology and the therapeutics of depression.
- Epidemiology of alcohol and drug use in the elderly(2013) WANG, Yuan-Pang; ANDRADE, Laura HelenaPurpose of review Alcohol and drug abuse among older adults is a topic of growing public health concern. The authors review the recent epidemiological surveys of this emerging trend and outline some public health challenges for the coming future. Recent findings Relevant studies showed that prevalence of substance use disorders is increasing among American and European elders. Although treatment admissions involving use of alcohol have slightly decreased, rates involving misuse of prescription medications and illicit drugs have increased. As older adults were less likely than younger adults to recognize substance use as problematic or to use treatment services, elders were as likely to benefit from treatment as younger people. Healthcare settings should be prepared to treat this population. Summary There is robust epidemiological evidence showing that alcohol and drug abuse among the elderly are current health problems in developed regions. The number of older adults will increase in less developed regions in the next decades, but it is unclear whether this population subgroup will also seek treatment for substance use to a greater extent. Investigations of the sexual difference and cross-cultural variation can help tailor effective interventions. Routine screening programmes to address the needs of the ageing substance-using population are recommended.
bookPart Transtornos de Ansiedade(2013) SILVEIRA, Camila Magalhães; SILVEIRA JUNIOR, Clóvis Castanho; WANG, Yuan-Pang; ANDRADE, Laura Helena- Days out-of-role due to common physical and mental health problems: Results from the Sao Paulo Megacity Mental Health Survey, Brazil(2013) ANDRADE, Laura Helena; BAPTISTA, Marcos C.; ALONSO, Jordi; PETUKHOVA, Maria; BRUFFAERTS, Ronny; KESSLER, Ronald C.; SILVEIRA, Camila M.; SIU, Erica R.; WANG, Yuan-Pang; VIANA, Maria CarmenOBJECTIVES: To investigate the relative importance of common physical and mental disorders with regard to the number of days out-of-role (DOR; number of days for which a person is completely unable to work or carry out normal activities because of health problems) in a population-based sample of adults in the Sao Paulo Metropolitan Area, Brazil. METHODS: The Sao Paulo Megacity Mental Health Survey was administered during face-to-face interviews with 2,942 adult household residents. The presence of 8 chronic physical disorders and 3 classes of mental disorders (mood, anxiety, and substance use disorders) was assessed for the previous year along with the number of days in the previous month for which each respondent was completely unable to work or carry out normal daily activities due to health problems. Using multiple regression analysis, we examined the associations of the disorders and their comorbidities with the number of days out-of-role while controlling for socio-demographic variables. Both individual-level and population-level associations were assessed. RESULTS: A total of 13.1% of the respondents reported 1 or more days out-of-role in the previous month, with an annual median of 41.4 days out-of-role. The disorders considered in this study accounted for 71.7% of all DOR; the disorders that caused the greatest number of DOR at the individual-level were digestive (22.6), mood (19.9), substance use (15.0), chronic pain (16.5), and anxiety (14.0) disorders. The disorders associated with the highest population-attributable DOR were chronic pain (35.2%), mood (16.5%), and anxiety (15.0%) disorders. CONCLUSIONS: Because pain, anxiety, and mood disorders have high effects at both the individual and societal levels, targeted interventions to reduce the impairments associated with these disorders have the highest potential to reduce the societal burdens of chronic illness in the Sao Paulo Metropolitan Area.