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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- 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.
- Alcohol Abuse in Developed and Developing Countries in the World Mental Health Surveys: Socially Defined Consequences or Psychiatric Disorder?(2014) GLANTZ, Meyer D.; MEDINA-MORA, Maria Elena; PETUKHOVA, Maria; ANDRADE, Laura Helena; ANTHONY, James C.; GIROLAMO, Giovanni de; GRAAF, Ron de; DEGENHARDT, Louisa; DEMYTTENAERE, Koen; FLORESCU, Silvia; GUREJE, Oye; HARO, Josep Maria; HORIGUCHI, Itsuko; KARAM, Elie G.; KOSTYUCHENKO, Stanislav; LEE, Sing; LEPINE, Jean-Pierre; MATSCHINGER, Herbert; NEUMARK, Yehuda; POSADA-VILLA, Jose; SAGAR, Rajesh; STEIN, Dan J.; TOMOV, Toma; WELLS, J. Elisabeth; CHATTERJI, Somnath; KESSLER, Ronald C.BackgroundPrevious single country research has raised concerns that: (1) the DSM-IV diagnosis of alcohol abuse (AA) is met primarily through the hazardous use criterion related to drinking and driving and (2) that the hazardous use and social consequences AA criteria primarily reflect varying socioeconomic and cultural factors rather than psychiatric disorder. MethodsUsing representative cross-national data from the 21 countries in the World Mental Health surveys, adults meeting DSM-IV lifetime criteria for AA but not dependence from 10 developed (n=46,071) and 11 developing (n=49,761) countries were assessed as meeting AA with the hazardous use or the social consequences criteria. ResultsBetween 29.3% (developed) and 16.2% (developing) of respondents with AA met only the hazardous use criterion. AA cases with and without hazardous use were similar in age-of-onset, course, predictors, and psychopathological consequences in both developed and developing countries. Discussion and ConclusionsDespite some associations of the AA criteria with socioeconomic factors, the hazardous use and social consequences criteria were significantly associated with psychiatric predictors and sequelae. The findings indicate that these criteria reflect psychiatric disorder and are appropriate for inclusion as DSM-5 Alcohol Use Disorder criteria. Scientific SignificanceThese findings support a psychiatric rather than a sociocultural view of the hazardous use and social consequences symptoms and provide evidence that they are appropriate diagnostic criteria cross-nationally with utility in a wide range of socioeconomic environments. This suggests consideration for their adoption by ICD-11. Further research is needed on the implications of these results for prevention and treatment. (Am J Addict 2014;23:145-155)
bookPart Diagnóstico clínico em Psiquiatria: o que muda com o DSM-5(2014) COêLHO, Bruno Mendonça; ANDRADE, Laura Helena Silveira Guerra de; WANG, Yuan-Pang- Under-reporting bipolar disorder in large-scale epidemiologic studies(2014) KARAM, Elie G.; SAMPSON, Nancy; ITANI, Lynn; ANDRADE, Laura Helena; BORGES, Guilherme; CHIU, Wai Tat; FLORESCU, Silvia; HORIGUCHI, Itsuko; ZARKOV, Zahari; AKISKAL, HagopBackground: To investigate if the prevalence of bipolar disorder in epidemiologic studies is an underestimate, as suggested by clinical studies. Methods: We analyzed data from 8 countries that participated in the World Mental Health Survey Initiative (n=47,552). We identified 6.8% and 18.9% of the sample who we think were screened out inappropriately (SCI) from the euphoric and irritable bipolar sections respectively. We compared them to those who were allowed to continue the section (CONT, 2.6% of the sample for euphoric; 1.0% for irritable) and to the reference group (REF, 69.5% of the sample). Results: The SCI group had consistently higher rates of major depression (29.1% vs. GA%), earlier age of onset (24.3 y vs. 32.4 y), more suicide attempts (13.3% vs. 5.9%), and more episodes (4.2 vs. 2.7) than the REF for the euphoric group. Similar findings exist for the irritable group. Also, comorbidity with anxiety, disruptive behavior disorders and substance use were much higher than the REF. Limitations: As with all epidemiologic studies, recall bias cannot be ruled out. Conclusions: The findings above suggest that a number of the SCI subjects belong to the bipolar group. A revision of instruments used in epidemiologic research will probably prove what clinical studies have been showing that bipolar disorder is more common than has been reported.
- DSM-5 latent classes of alcohol users in a population-based sample: Results from the Sao Paulo Megacity Mental Health Survey, Brazil(2014) CASTALDELLI-MAIA, Joao Mauricio; SILVEIRA, Camila M.; SIU, Erica R.; WANG, Yuan-Pang; MILHORANCA, Igor A.; ALEXANDRINO-SILVA, Clovis; BORGES, Guilherme; VIANA, Maria C.; ANDRADE, Arthur G.; ANDRADE, Laura H.; MARTINS, Silvia S.Background: We aimed to identify different categorical phenotypes based upon the DSM-V criteria of alcohol use disorders (AUD) among alcohol users who had at least one drink per week in the past year (n = 948). Methods: Data are from the Sao Paulo Megacity Mental Health Survey collected in 2005-2007, as part of the World Mental Health Survey Initiative. A latent class analysis of the 11 DSM-5-AUD criteria was performed using Mplus, taking into account complex survey design features. Weighted logistic regression models were used to examine demographic correlates of the DSM-5-AUD latent classes. Results: The best latent-class model was a three-class model. We found a ""non-symptomatic class"" (69.7%), a ""use in larger amounts class"" (23.2%), defined by high probability (>70%) of the ""use in larger amounts"" criterion only, and a ""high-moderate symptomatic class"" (7.1%), defined by high-moderate probability of all the 11 AUD criteria. Compared to those in the non-symptomatic class, individuals in the ""high-moderate symptomatic class"" were more likely to have been married, have lower educational attainment and to be unemployed or in non-regular/informal employment. Those on the ""use in larger amounts class"" were more likely to have been married or never married. Conclusion: The two symptomatic classes clearly represented the dimensionality of the new proposed AUD criteria, and could be more specifically targeted by different prevention or treatment strategies. DSM-5-AUD has the advantage of shedding light on risky drinkers included in the ""use in larger amounts class"", allowing for preventive interventions, which will reach a large number of individuals.
- Comorbidity of common mental disorders with cancer and their treatment gap: findings from the World Mental Health Surveys(2014) NAKASH, Ora; LEVAV, Itzhak; AGUILAR-GAXIOLA, Sergio; ALONSO, Jordi; ANDRADE, Laura Helena; ANGERMEYER, Matthias C.; BRUFFAERTS, Ronny; CALDAS-DE-ALMEIDA, Jose Miguel; FLORESCU, Slivia; GIROLAMO, Giovanni de; GUREJE, Oye; HE, Yanling; HU, Chiyi; JONGE, Peter de; KARAM, Elie G.; KOVESS-MASFETY, Viviane; MEDINA-MORA, Maria Elena; MOSKALEWICZ, Jacek; MURPHY, Sam; NAKAMURA, Yosikazu; PIAZZA, Marina; POSADA-VILLA, Jose; STEIN, Dan J.; TAIB, Nezar Ismet; ZARKOV, Zahari; KESSLER, Ronald C.; SCOTT, Kate M.ObjectiveThis study aimed to study the comorbidity of common mental disorders (CMDs) and cancer, and the mental health treatment gap among community residents with active cancer, cancer survivors and cancer-free respondents in 13 high-income and 11 low-middle-income countries. MethodsData were derived from the World Mental Health Surveys (N=66,387; n=357 active cancer, n=1373 cancer survivors, n=64,657 cancer-free respondents). The World Health Organization/Composite International Diagnostic Interview was used in all surveys to estimate CMDs prevalence rates. Respondents were also asked about mental health service utilization in the preceding 12months. Cancer status was ascertained by self-report of physician's diagnosis. ResultsTwelve-month prevalence rates of CMDs were higher among active cancer (18.4%, SE=2.1) than cancer-free respondents (13.3%, SE=0.2) adjusted for sociodemographic confounders and other lifetime chronic conditions (adjusted odds ratio (AOR)=1.44, 95% CI 1.05-1.97). CMD rates among cancer survivors (14.6%, SE=0.9) compared with cancer-free respondents did not differ significantly (AOR=0.95, 95% CI 0.82-1.11). Similar patterns characterized high-income and low-middle-income countries. Of respondents with active cancer who had CMD in the preceding 12months, 59% sought services for mental health problems (SE=5.3). The pattern of service utilization among people with CMDs by cancer status (highest among persons with active cancer, lower among survivors and lowest among cancer-free respondents) was similar in high-income (64.0%, SE=6.0; 41.2%, SE=3.0; 35.6%, SE=0.6) and low-middle-income countries (46.4%, SE=11.0; 22.5%, SE=9.1; 17.4%, SE=0.7). ConclusionsCommunity respondents with active cancer have higher CMD rates and high treatment gap. Comprehensive cancer care should consider both factors.
- MAJOR DEPRESSIVE DISORDER SUBTYPES TO PREDICT LONG-TERM COURSE(2014) LOO, Hanna M. van; CAI, Tianxi; GRUBER, Michael J.; LI, Junlong; JONGE, Peter de; PETUKHOVA, Maria; ROSE, Sherri; SAMPSON, Nancy A.; SCHOEVERS, Robert A.; WARDENAAR, Klaas J.; WILCOX, Marsha A.; AL-HAMZAWI, Ali Obaid; ANDRADE, Laura Helena; BROMET, Evelyn J.; BUNTING, Brendan; FAYYAD, John; FLORESCU, Silvia E.; GUREJE, Oye; HU, Chiyi; HUANG, Yueqin; LEVINSON, Daphna; MEDINA-MORA, Maria Elena; NAKANE, Yoshibumi; POSADA-VILLA, Jose; SCOTT, Kate M.; XAVIER, Miguel; ZARKOV, Zahari; KESSLER, Ronald C.BackgroundVariation in the course of major depressive disorder (MDD) is not strongly predicted by existing subtype distinctions. A new subtyping approach is considered here. MethodsTwo data mining techniques, ensemble recursive partitioning and Lasso generalized linear models (GLMs), followed by k-means cluster analysis are used to search for subtypes based on index episode symptoms predicting subsequent MDD course in the World Mental Health (WMH) surveys. The WMH surveys are community surveys in 16 countries. Lifetime DSM-IV MDD was reported by 8,261 respondents. Retrospectively reported outcomes included measures of persistence (number of years with an episode, number of years with an episode lasting most of the year) and severity (hospitalization for MDD, disability due to MDD). ResultsRecursive partitioning found significant clusters defined by the conjunctions of early onset, suicidality, and anxiety (irritability, panic, nervousness-worry-anxiety) during the index episode. GLMs found additional associations involving a number of individual symptoms. Predicted values of the four outcomes were strongly correlated. Cluster analysis of these predicted values found three clusters having consistently high, intermediate, or low predicted scores across all outcomes. The high-risk cluster (30.0% of respondents) accounted for 52.9-69.7% of high persistence and severity, and it was most strongly predicted by index episode severe dysphoria, suicidality, anxiety, and early onset. A total symptom count, in comparison, was not a significant predictor. ConclusionsDespite being based on retrospective reports, results suggest that useful MDD subtyping distinctions can be made using data mining methods. Further studies are needed to test and expand these results with prospective data. (C) 2014 Wiley Periodicals, Inc.
- Associations Between Subjective Social Status and DSM-IV Mental Disorders Results From the World Mental Health Surveys(2014) SCOTT, Kate M.; AL-HAMZAWI, Ali Obaid; ANDRADE, Laura H.; BORGES, Guilherme; CALDAS-DE-ALMEIDA, Jose Miguel; FIESTAS, Fabian; GUREJE, Oye; HU, Chiyi; KARAM, Elie G.; KAWAKAMI, Norito; LEE, Sing; LEVINSON, Daphna; LIM, Carmen C. W.; NAVARRO-MATEU, Fernando; OKOLIYSKI, Michail; POSADA-VILLA, Jose; TORRES, Yolanda; WILLIAMS, David R.; ZAKHOZHA, Victoria; KESSLER, Ronald C.IMPORTANCE The inverse social gradient in mental disorders is a well-established research finding with important implications for causal models and policy. This research has used traditional objective social status (OSS) measures, such as educational level, income, and occupation. Recently, subjective social status (SSS) measurement has been advocated to capture the perception of relative social status, but to our knowledge, there have been no studies of associations between SSS and mental disorders. OBJECTIVES To estimate associations of SSS with DSM-IV mental disorders in multiple countries and to investigate whether the associations persist after comprehensive adjustment of OSS. DESIGN, SETTING, AND PARTICIPANTS Face-to-face cross-sectional household surveys of community-dwelling adults in 18 countries in Asia, South Pacific, the Americas, Europe, and the Middle East (N = 56 085). Subjective social status was assessed with a self-anchoring scale reflecting respondent evaluations of their place in the social hierarchies of their countries in terms of income, educational level, and occupation. Scores on the 1 to 10 SSS scale were categorized into 4 categories: low (scores 1-3), low-mid (scores 4-5), high-mid (scores 6-7), and high (scores 8-10). Objective social status was assessed with a wide range of fine-grained objective indicators of income, educational level, and occupation. MAIN OUTCOMES AND MEASURES The Composite International Diagnostic Interview assessed the 12-month prevalence of 16 DSM-IV mood, anxiety, and impulse control disorders. RESULTS The weighted mean survey response rate was 75.2%(range, 55.1%-97.2%). Graded inverse associations were found between SSS and all 16 mental disorders. Gross odds ratios (lowest vs highest SSS categories) in the range of 1.8 to 9.0 were attenuated but remained significant for all 16 disorders (odds ratio, 1.4-4.9) after adjusting for OSS indicators. This pattern of inverse association between SSS and mental disorders was significant in 14 of 18 individual countries, and in low-, middle-, and high-income country groups but was significantly stronger in high-vs lower-income countries. CONCLUSIONS AND RELEVANCE Significant inverse associations between SSS and numerous DSM-IV mental disorders exist across a wide range of countries even after comprehensive adjustment for OSS. Although it is unclear whether these associations are the result of social selection, social causation, or both, these results document clearly that research relying exclusively on standard OSS measures underestimates the steepness of the social gradient in mental disorders.
- A comparative analysis of role attainment and impairment in binge-eating disorder and bulimia nervosa: results from the WHO World Mental Health Surveys(2014) KESSLER, R. C.; SHAHLY, V.; HUDSON, J. I.; SUPINA, D.; BERGLUND, P. A.; CHIU, W. T.; GRUBER, M.; AGUILAR-GAXIOLA, S.; ALONSO, J.; ANDRADE, L. H.; BENJET, C.; BRUFFAERTS, R.; GIROLAMO, G. de; GRAAF, R. de; FLORESCU, S. E.; HARO, J. M.; MURPHY, S. D.; POSADA-VILLA, J.; SCOTT, K.; XAVIER, M.Background. Cross-national population data from the WHO World Mental Health surveys are used to compare role attainments and role impairments associated with binge-eating disorder (BED) and bulimia nervosa (BN). Methods. Community surveys assessed 23000 adults across 12 countries for BED, BN and ten other DSM-IV mental disorders using the WHO Composite International Diagnostic Interview. Age-of-onset was assessed retrospectively. Ten physical disorders were assessed using standard conditions checklists. Analyses examined reciprocal time-lagged associations of eating disorders (EDs) with education, associations of early-onset (i.e., prior to completing education) EDs with subsequent adult role attainments and cross-sectional associations of current EDs with days of role impairment. Results. BED and BN predicted significantly increased education (females). Student status predicted increased risk of subsequent BED and BN (females). Early-onset BED predicted reduced odds of current (at time of interview) marriage (females) and reduced odds of current employment (males). Early-onset BN predicted increased odds of current work disability (females and males). Current BED and BN were both associated with significantly increased days of role impairment (females and males). Significant BED and BN effects on adult role attainments and impairments were explained by controls for comorbid disorders. Conclusions. Effects of BED on role attainments and impairments are comparable with those of BN. The most plausible interpretation of the fact that these associations are explained by comorbid disorders is that causal effects of EDs are mediated through secondary disorders. Controlled treatment effectiveness studies are needed to trace out long-term effects of BED-BN on secondary disorders.
conferenceObject Patterns of multimorbidity in the general population of Sao Paulo, Brazil: a retrospective observational study(2014) WANG, Yuan-Pang; CHIAVEGATTO-FILHO, Alexandre D. P.; BENSENOR, Isabela M.; VIANA, Maria Carmen; ANDRADE, Laura H.