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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- 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.
- 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.
- The cross-national epidemiology of specific phobia in the World Mental Health Surveys(2017) WARDENAAR, K. J.; LIM, C. C. W.; AL-HAMZAWI, A. O.; ALONSO, J.; ANDRADE, L. H.; BENJET, C.; BUNTING, B.; GIROLAMO, G. de; DEMYTTENAERE, K.; FLORESCU, S. E.; GUREJE, O.; HISATERU, T.; HU, C.; HUANG, Y.; KARAM, E.; KIEJNA, A.; LEPINE, J. P.; NAVARRO-MATEU, F.; BROWNE, M. Oakley; PIAZZA, M.; POSADA-VILLA, J.; HAVE, M. L. ten; TORRES, Y.; XAVIER, M.; ZARKOV, Z.; KESSLER, R. C.; SCOTT, K. M.; JONGE, P. deBackground. Although specific phobia is highly prevalent, associated with impairment, and an important risk factor for the development of other mental disorders, cross-national epidemiological data are scarce, especially from low- and middle-income countries. This paper presents epidemiological data from 22 low-, lower-middle-, upper-middle- and high-income countries. Method. Data came from 25 representative population-based surveys conducted in 22 countries (2001-2011) as part of the World Health Organization World Mental Health Surveys initiative (n = 124 902). The presence of specific phobia as defined by the Diagnostic and Statistical Manual of Mental Disorders, fourth edition was evaluated using the World Health Organization Composite International Diagnostic Interview. Results. The cross-national lifetime and 12-month prevalence rates of specific phobia were, respectively, 7.4% and 5.5%, being higher in females (9.8 and 7.7%) than in males (4.9% and 3.3%) and higher in high- and higher-middle-income countries than in low-/lower-middle-income countries. The median age of onset was young (8 years). Of the 12-month patients, 18.7% reported severe role impairment (13.3-21.9% across income groups) and 23.1% reported any treatment (9.6-30.1% across income groups). Lifetime co-morbidity was observed in 60.5% of those with lifetime specific phobia, with the onset of specific phobia preceding the other disorder in most cases (72.6%). Interestingly, rates of impairment, treatment use and co-morbidity increased with the number of fear subtypes. Conclusions. Specific phobia is common and associated with impairment in a considerable percentage of cases. Importantly, specific phobia often precedes the onset of other mental disorders, making it a possible early-life indicator of psychopathology vulnerability.
- The role of religious advisors in mental health care in the World Mental Health surveys(2017) KOVESS-MASFETY, Vivianne; EVANS-LACKO, Sara; WILLIAMS, David; ANDRADE, Laura Helena; BENJET, Corina; HAVE, Margreet Ten; WARDENAAR, Klaas; KARAM, Elie G.; BRUFFAERTS, Ronny; ABDUMALIK, Jibril; ABAD, Josep Maria Haro; FLORESCU, Silvia; WU, Benjamin; JONGE, Peter De; ALTWAIJRI, Yasmina; HINKOV, Hristo; KAWAKAMI, Norito; CALDAS-DE-ALMEIDA, Jose Miguel; BROMET, Evelyn; GIROLAMO, Giovanni de; POSADA-VILLA, Jose; AL-HAMZAWI, Ali; HUANG, Yueqin; HU, Chiyi; VIANA, Maria Carmen; FAYYAD, John; MEDINA-MORA, Maria Elena; DEMYTTENAERE, Koen; LEPINE, Jean-Pierre; MURPHY, Samuel; XAVIER, Miguel; TAKESHIMA, Tadashi; GUREJE, OyeTo examine the role of religious advisors in mental health care (MHC) according to disorder severity, socio-demographics, religious involvement and country income groups. Face to face household surveys in ten high income (HI), six upper-middle income (UMI) and five low/lower-middle (LLMI) income countries totalling 101,258 adults interviewed with the WMH CIDI plus questions on use of care for mental health problems and religiosity. 1.1% of participants turned to religious providers for MHC in the past year. Among those using services, 12.3% used religious services; as much as 30% in some LLMI countries, around 20% in some UMI; in the HI income countries USA, Germany, Italy and Japan are between 15 and 10% whenever the remaining countries are much lower. In LLMI 20.9% used religious advisors for the most severe mental disorders compared to 12.3 in UMI and 9.5% in HI. For severe cases most of religious providers use occurred together with formal care except in Nigeria, Iraq and Ukraine where, respectively, 41.6, 25.7 and 17.7% of such services are outside any formal care. Frequency of attendance at religious services was a strong predictor of religious provider usage OR 6.5 for those who attended over once a week (p < 0.0001); as seeking comfort ""often"" through religion in case of difficulties OR was 3.6 (p = 0.004) while gender and individual income did not predict use of religious advisors nor did the type of religious affiliation; in contrast young people use them more as well as divorced and widowed OR 1.4 (p = 0.02). Some country differences persisted after controlling for all these factors. Religious advisors play an important role in mental health care and require appropriate training and collaboration with formal mental healthcare systems. Religious attitudes are strong predictors of religious advisors usage.
- Mental disorders among college students in the World Health Organization World Mental Health Surveys (vol 46, pg 2955, 2016)(2017) AUERBACH, R. P.; ALONSO, J.; AXINN, W. G.; CUIJPERS, P.; EBERT, D. D.; GREEN, J. G.; HWANG, I.; KESSLER, R. C.; LIU, H.; MORTIER, P.; NOCK, M. K.; PINDER-AMAKER, S.; SAMPSON, N. A.; AGUILAR-GAXIOLA, S.; AL-HAMZAWI, A.; ANDRADE, L. H.; BENJET, C.; CALDAS-DE-ALMEIDA, J. M.; DEMYTTENAERE, K.; FLORESCU, S.; GIROLAMO, G. de; GUREJE, O.; HARO, J. M.; KARAM, E. G.; KIEJNA, A.; KOVESS-MASFETY, V.; LEE, S.; MCGRATH, J. J.; O'NEILL, S.; PENNELL, B. -E.; SCOTT, K.; HAVE, M. ten; TORRES, Y.; ZASLAVSKY, A. M.; ZARKOV, Z.; BRUFFAERTS, R.
- Mental disorders and employment status in the Sao Paulo Metropolitan Area, Brazil: gender differences and use of health services(2017) FRANCA, Mariane Henriques; BARRETO, Sandhi Maria; PEREIRA, Flavia Garcia; ANDRADE, Laura Helena Silveira Guerra de; PAIVA, Maria Cristina Alochio de; VIANA, Maria CarmenMental disorders are associated with employment status as significant predictors and as consequences of unemployment and early retirement. This study describes the estimates and associations of 12-month DSM-IV prevalence rates of mental disorders and use of health services with employment status by gender in the Sao Paulo Metropolitan Area, Brazil. Data from the Sao Paulo Megacity Mental Health Survey was analyzed (n = 5,037). This is a population-based study assessing the prevalence and determinants of mental disorders among adults, using the Composite International Diagnostic Interview. The associations were estimated by odds ratios obtained through binomial and multinomial logistic regression. This study demonstrates that having mental disorders, especially mood disorders, is associated with being inactive or unemployed among men and inactive among women, but only having a substance use disorder is associated with being unemployed among women. Among those with mental disorders, seeking health care services is less frequent within unemployed.
conferenceObject - The association between psychotic experiences and disability: results from the WHO World Mental Health Surveys(2017) NAVARRO-MATEU, F.; ALONSO, J.; LIM, C. C. W.; SAHA, S.; AGUILAR-GAXIOLA, S.; AL-HAMZAWI, A.; ANDRADE, L. H.; BROMET, E. J.; BRUFFAERTS, R.; CHATTERJI, S.; DEGENHARDT, L.; GIROLAMO, G. de; JONGE, P. de; FAYYAD, J.; FLORESCU, S.; GUREJE, O.; HARO, J. M.; HU, C.; KARAM, E. G.; KOVESS-MASFETY, V.; LEE, S.; MEDINA-MORA, M. E.; OJAGBEMI, A.; PENNELL, B. -E.; PIAZZA, M.; POSADA-VILLA, J.; SCOTT, K. M.; STAGNARO, J. C.; XAVIER, M.; KENDLER, K. S.; KESSLER, R. C.; MCGRATH, J. J.Objective: While psychotic experiences (PEs) are known to be associated with a range of mental and general medical disorders, little is known about the association between PEs and measures of disability. We aimed to investigate this question using the World Mental Health surveys. Method: Lifetime occurrences of six types of PEs were assessed along with 21 mental disorders and 14 general medical conditions. Disability was assessed with a modified version of the WHO Disability Assessment Schedule. Descriptive statistics and logistic regression models were used to investigate the association between PEs and high disability scores (top quartile) with various adjustments. Results: Respondents with PEs were more likely to have top quartile scores on global disability than respondents without PEs (19.1% vs. 7.5%; chi(2) = 190.1, P < 0.001) as well as greater likelihood of cognitive, social, and role impairment. Relationships persisted in each adjusted model. A significant dose-response relationship was also found for the PE type measures with most of these outcomes. Conclusions: Psychotic experiences are associated with disability measures with a dose-response relationship. These results are consistent with the view that PEs are associated with disability regardless of the presence of comorbid mental or general medical disorders.
- The descriptive epidemiology of DSM-IV Adult ADHD in the World Health Organization World Mental Health Surveys(2017) FAYYAD, John; SAMPSON, Nancy A.; HWANG, Irving; ADAMOWSKI, Tomasz; AGUILAR-GAXIOLA, Sergio; AL-HAMZAWI, Ali; ANDRADE, Laura H. S. G.; BORGES, Guilherme; GIROLAMO, Giovanni de; FLORESCU, Silvia; GUREJE, Oye; HARO, Josep Maria; HU, Chiyi; KARAM, Elie G.; LEE, Sing; NAVARRO-MATEU, Fernando; O'NEILL, Siobhan; PENNELL, Beth-Ellen; PIAZZA, Marina; POSADA-VILLA, Jose; HAVE, Margreet ten; TORRES, Yolanda; XAVIER, Miguel; ZASLAVSKY, Alan M.; KESSLER, Ronald C.We previously reported on the cross-national epidemiology of ADHD from the first 10 countries in the WHO World Mental Health (WMH) Surveys. The current report expands those previous findings to the 20 nationally or regionally representative WMH surveys that have now collected data on adult ADHD. The Composite International Diagnostic Interview (CIDI) was administered to 26,744 respondents in these surveys in high-, upper-middle-, and low-/lower-middle-income countries (68.5% mean response rate). Current DSM-IV/CIDI adult ADHD prevalence averaged 2.8% across surveys and was higher in high (3.6%)- and upper-middle (3.0%)- than low-/lower-middle (1.4%)-income countries. Conditional prevalence of current ADHD averaged 57.0% among childhood cases and 41.1% among childhood subthreshold cases. Adult ADHD was significantly related to being male, previously married, and low education. Adult ADHD was highly comorbid with DSM-IV/CIDI anxiety, mood, behavior, and substance disorders and significantly associated with role impairments (days out of role, impaired cognition, and social interactions) when controlling for comorbidities. Treatment seeking was low in all countries and targeted largely to comorbid conditions rather than to ADHD. These results show that adult ADHD is prevalent, seriously impairing, and highly comorbid but vastly under-recognized and undertreated across countries and cultures.
- Prevalence and clinical profile of chronic pain and its association with mental disorders(2017) PEREIRA, Flavia Garcia; FRANCA, Mariane Henriques; PAIVA, Maria Cristina Alochio de; ANDRADE, Laura Helena; VIANA, Maria CarmenOBJECTIVE: To identify the prevalence of 12-month self-reported pain and chronic pain in a general population and to describe their clinical profile to assess if chronic pain is associated with 12-month mental disorders. METHODS: The data used comes from the Sao Paulo Megacity Mental Health Survey, a population-based study assessing adult (>= 18 years) residents of the Sao Paulo metropolitan area, Brazil. We have assessed the respondents (n = 5,037) using the Composite International Diagnostic Interview (CIDI 3.0), with a global response rate of 81.3%. Descriptive analyses have been performed, and crude and adjusted odds ratios (OR) have been calculated with logistic and multinomial regression and presented with respective 95% confidence intervals (95%CI). RESULTS: The prevalence of pain and chronic pain in the past 12 months were 52.6% (95%CI 50.3-54.8) and 31.0% (95%CI 29.2-32.7), respectively. Joints (16.5%, 95%CI 15.4-17.5) and back or neck (15.5%, 95%CI 14.2-16.9) were the most frequently reported anatomical sites of chronic pain. On a 10-point analogue scale, the mean intensity of the worst pain was 7.7 (95%CI 7.4-7.8), and the mean average pain was 5.5 (95%CI 5.2-5.6); the mean treatment response was 6.3 (95%CI 6.0-6.6). Mean pain duration was 16.1 (95%CI 15.6-17.0) days a month and 132 (95%CI 126-144) minutes a day. Chronic pain was associated with 12-month DSM-IV mental disorders (OR = 2.7, 95% CI 2.3-3.3), anxiety disorders (OR = 2.1, 95% CI 1.9-3.0), and mood disorders (OR = 3.3, 95% CI 2.4-4.1). CONCLUSIONS: A high prevalence of chronic pain in multiple sites is observed among the general adult population, and associations between chronic pain and mental disorders are frequent.