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
14 resultados
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- Investigating the Dimensional Diagnosis of ICD-11 Nicotine Dependence(2018) CASTALDELLI-MAIA, Joao Mauricio; MARTINS, Silvia S.; STORR, Carla L.; VIANA, Maria C.; ANDRADE, Laura H.; ANDRADE, Arthur G.We investigated the dimensionality and possible measurement bias of ICD-11 Nicotine Dependence (ND) criteria in a sample of smokers from a middle-income country. Data are from the Sao Paulo Megacity Project (part of World Mental Health Surveys) collected between 2005 and 2007 (n = 5,037). The current analyses were restricted to the 1,388 participants who smoked at least once a week for 2 months in their lifetime. Item response theory (IRT) was used to investigate the severity and discrimination properties of 8 selected criteria. Additionally, differential criteria functioning (DCF) with sociodemographic characteristics (income, gender, age, employment status, marital status, and education) was investigated. All analyses were performed in Mplus software taking into account complex survey design features. IRT results indicated that the criterion Given Up had the lowest probability of endorsement (highest severity). The criterion Larger/Longer had the highest probability of endorsement (lowest severity), but the highest value of discrimination. Physical Withdrawal had the lowest discrimination property. No DCF was found both at criterion-and disorder-level, which would tear measurement bias. The absence of measurement bias in all sociodemographic, psychiatric, and medical subgroups gives psychometrical support to this set of criteria for ICD-11 ND diagnosis.
- Response pattern of depressive symptoms among college students: What lies behind items of the Beck Depression Inventory-II ?(2018) SA JUNIOR, Antonio Reis de; ANDRADE, Arthur Guerra de; ANDRADE, Laura Helena; GORENSTEIN, Clarice; WANG, Yuan-PangBackground: This study examines the response pattern of depressive symptoms in a nationwide student sample, through item analyses of a rating scale by both classical test theory (CTT) and item response theory (IRT). Methods: The 21-item Beck Depression Inventory-II (BDI-II) was administered to 12,711 college students. First, the psychometric properties of the scale were described. Thereafter, the endorsement probability of depressive symptom in each scale item was analyzed through CTT and IRT. Graphical plots depicted the endorsement probability of scale items and intensity of depression. Three items of different difficulty level were compared through CTT and IRT approach. Results: Four in five students reported the presence of depressive symptoms. The BDI-II items presented good reliability and were distributed along the symptomatic continuum of depression. Similarly, in both CTT and IRT approaches, the item 'changes in sleep' was easily endorsed, 'loss of interest' moderately and 'suicidal thoughts' hardly. Graphical representation of BDI-II of both methods showed much equivalence in terms of item discrimination and item difficulty. The item characteristic curve of the IRT method provided informative evaluation of item performance. Limitation: The inventory was applied only in college students. Conclusion: Depressive symptoms were frequent psychopathological manifestations among college students. The performance of the BDI-II items indicated convergent results from both methods of analysis. While the CTT was easy to understand and to apply, the IRT was more complex to understand and to implement. Comprehensive assessment of the functioning of each BDI-II item might be helpful in efficient detection of depressive conditions in college students.
- The cross-national structure of mental disorders: results from the World Mental Health Surveys(2018) JONGE, Peter de; WARDENAAR, Klaas J.; LIM, Carmen C. W.; AGUILAR-GAXIOLA, Sergio; ALONSO, Jordi; ANDRADE, Laura Helena; BUNTING, Brendan; CHATTERJI, Somnath; CIUTAN, Marius; GUREJE, Oye; KARAM, Elie G.; LEE, Sing; MEDINA-MORA, Maria Elena; MOSKALEWICZ, Jacek; NAVARRO-MATEU, Fernando; PENNELL, Beth-Ellen; PIAZZA, Marina; POSADA-VILLA, Jose; TORRES, Yolanda; KESSLER, Ronald C.; SCOTT, KateBackgroundThe patterns of comorbidity among mental disorders have led researchers to model the underlying structure of psychopathology. While studies have suggested a structure including internalizing and externalizing disorders, less is known with regard to the cross-national stability of this model. Moreover, little data are available on the placement of eating disorders, bipolar disorder and psychotic experiences (PEs) in this structure.MethodsWe evaluated the structure of mental disorders with data from the World Health Organization Composite International Diagnostic Interview, including 15 lifetime mental disorders and six PEs. Respondents (n = 5478-15 499) were included from 10 high-, middle- and lower middle-income countries across the world aged 18 years or older. Confirmatory factor analyses (CFAs) were used to evaluate and compare the fit of different factor structures to the lifetime disorder data. Measurement invariance was evaluated with multigroup CFA (MG-CFA).ResultsA second-order model with internalizing and externalizing factors and fear and distress subfactors best described the structure of common mental disorders. MG-CFA showed that this model was stable across countries. Of the uncommon disorders, bipolar disorder and eating disorder were best grouped with the internalizing factor, and PEs with a separate factor.ConclusionsThese results indicate that cross-national patterns of lifetime common mental-disorder comorbidity can be explained with a second-order underlying structure that is stable across countries and can be extended to also cover less common mental disorders.
- The associations between psychotic experiences and substance use and substance use disorders: findings from the World Health Organization World Mental Health surveys(2018) DEGENHARDT, Louisa; SAHA, Sukanta; LIM, Carmen C. W.; AGUILAR-GAXIOLA, Sergio; AL-HAMZAWI, Ali; ALONSO, Jordi; ANDRADE, Laura H.; BROMET, Evelyn J.; BRUFFAERTS, Ronny; CALDAS-DE-ALMEIDA, Jose Miguel; GIROLAMO, Giovanni de; FLORESCU, Silvia; GUREJE, Oye; HARO, Josep M.; KARAM, Elie G.; KARAM, Georges; KOVESS-MASFETY, Viviane; LEE, Sing; LEPINE, Jean-Pierre; MAKANJUOLA, Victor; MEDINA-MORA, Maria E.; MNEIMNEH, Zeina; NAVARRO-MATEU, Fernando; PIAZZA, Marina; POSADA-VILLA, Jose; SAMPSON, Nancy A.; SCOTT, Kate M.; STAGNARO, Juan Carlos; HAVE, Margreet Ten; KENDLER, Kenneth S.; KESSLER, Ronald C.; MCGRATH, John J.Background and aims Prior research has found bidirectional associations between psychotic experiences (PEs) and selected substance use disorders. We aimed to extend this research by examining the bidirectional association between PEs and various types of substance use (SU) and substance use disorders (SUDs), and the influence of antecedent mental disorders on these associations. Design, setting, participants and measurements We used data from the World Health Organization World Mental Health surveys. A total of 30902 adult respondents across 18 countries were assessed for (a) six types of life-time PEs, (b) a range of types of SU and DSM-IV SUDs and (c) mental disorders using the Composite International Diagnostic Interview. Discrete-time survival analyses based on retrospective age-at-onset reports examined the bidirectional associations between PEs and SU/SUDs controlling for antecedent mental disorders. Findings After adjusting for demographics, comorbid SU/SUDs and antecedent mental disorders, those with prior alcohol use disorders [odds ratio (OR)=1.6, 95% confidence interval (CI)=1.2-2.0], extra-medical prescription drug use (OR=1.5, 95% CI=1.1-1.9), alcohol use (OR=1.4, 95% CI=1.1-1.7) and tobacco use (OR=1.3, 95% CI=1.0-1.8) had increased odds of subsequent first onset of PEs. In contrast, those with temporally prior PEs had increased odds of subsequent onset of tobacco use (OR=1.5, 95% CI=1.2-1.9), alcohol use (OR=1.3, 95% CI=1.1-1.6) or cannabis use (OR=1.3, 95% CI=1.0-1.5) as well as of all substance use disorders (ORs ranged between 1.4 and 1.5). There was a dose response relationship between both count and frequency of PEs and increased subsequent odds of selected SU/SUDs. Conclusions Associations between psychotic experiences (PEs) and substance use/substance use disorders (SU/SUDs) are often bidirectional, but not all types of SU/SUDs are associated with PEs. These findings suggest that it is important to be aware of the presence of PEs within those with SUDs or at risk of SUDs, given the plausibility that they may each impact upon the other.
- Complementary and alternative medicine contacts by persons with mental disorders in 25 countries: results from the World Mental Health Surveys(2018) JONGE, P. de; WARDENAAR, K. J.; HOENDERS, H. R.; EVANS-LACKO, S.; KOVESS-MASFETY, V.; AGUILAR-GAXIOLA, S.; AL-HAMZAWI, A.; ALONSO, J.; ANDRADE, L. H.; BENJET, C.; BROMET, E. J.; BRUFFAERTS, R.; BUNTING, B.; CALDAS-DE-ALMEIDA, J. M.; DINOLOVA, R. V.; FLORESCU, S.; GIROLAMO, G. de; GUREJE, O.; HARO, J. M.; HU, C.; HUANG, Y.; KARAM, E. G.; KARAM, G.; LEE, S.; LEPINE, J. -P.; LEVINSON, D.; MAKANJUOLA, V.; NAVARRO-MATEU, F.; PENNELL, B. -E.; POSADA-VILLA, J.; SCOTT, K.; TACHIMORI, H.; WILLIAMS, D.; WOJTYNIAK, B.; KESSLER, R. C.; THORNICROFTON, G.Aims.A substantial proportion of persons with mental disorders seek treatment from complementary and alternative medicine (CAM) professionals. However, data on how CAM contacts vary across countries, mental disorders and their severity, and health care settings is largely lacking. The aim was therefore to investigate the prevalence of contacts with CAM providers in a large cross-national sample of persons with 12-month mental disorders. Methods.In the World Mental Health Surveys, the Composite International Diagnostic Interview was administered to determine the presence of past 12 month mental disorders in 138 801 participants aged 18-100 derived from representative general population samples. Participants were recruited between 2001 and 2012. Rates of self-reported CAM contacts for each of the 28 surveys across 25 countries and 12 mental disorder groups were calculated for all persons with past 12-month mental disorders. Mental disorders were grouped into mood disorders, anxiety disorders or behavioural disorders, and further divided by severity levels. Satisfaction with conventional care was also compared with CAM contact satisfaction. Results. An estimated 3.6% (standard error 0.2%) of persons with a past 12-month mental disorder reported a CAM contact, which was two times higher in high-income countries (4.6%; standard error 0.3%) than in low- and middle-income countries (2.3%; standard error 0.2%). CAM contacts were largely comparable for different disorder types, but particularly high in persons receiving conventional care (8.6-17.8%). CAM contacts increased with increasing mental disorder severity. Among persons receiving specialist mental health care, CAM contacts were reported by 14.0% for severe mood disorders, 16.2% for severe anxiety disorders and 22.5% for severe behavioural disorders. Satisfaction with care was comparable with respect to CAM contacts (78.3%) and conventional care (75.6%) in persons that received both. Conclusions.CAM contacts are common in persons with severe mental disorders, in high-income countries, and in persons receiving conventional care. Our findings support the notion of CAM as largely complementary but are in contrast to suggestions that this concerns person with only mild, transient complaints. There was no indication that persons were less satisfied by CAM visits than by receiving conventional care. We encourage health care professionals in conventional settings to openly discuss the care patients are receiving, whether conventional or not, and their reasons for doing so.
- Gender differences in tobacco use disorder phenotypes among smokers in the largest metropolitan area of South America(2018) CASTALDELLI-MAIA, J. M.; MARTINS, S.; ANDRADE, L.
- The role of gender in the structure of networks of childhood adversity(2018) COELHO, Bruno Mendonca; SANTANA, Geilson Lima; DUARTE-GUERRA, Leorides Severo; VIANA, Maria Carmen; NETO, Francisco Lotufo; ANDRADE, Laura Helena; WANG, Yuan-PangThe objective of present study is to investigate the relationship between different childhood adversities. The potential impact of early adversity on prevention programs is discussed. Data on twelve childhood adversities was collected from a representative sample of 5037 members of the general population living in a large metropolitan area. Data were analyzed through network analysis, to estimate and compare network connectivity and centrality measures by gender. Over half the respondents had been exposed to at least one adversity during their earlier developmental stage. Among adversity-exposed persons, 48.4% presented simultaneous adversities, most of which were related to 'family dysfunction' and 'maltreatment' (mean = 2.9 adversities). Women reported more adversities than men (59.0% vs. 47.6%). Although the 'global' network connectivity across adversities was similar in both genders, 'regional' distinctions in the network structure were found. While 'neglect' and 'parental death' were more important for women than men, 'parental mental disorders' was more important for men. Gender-related childhood adversities were clustered experiences. Adversities related to 'early family dysfunction' and 'maltreatment' were prominent features in the networks of both boys and girls. Differential preventive and intervention programs should take into account gender-related patterns of exposure and reporting patterns of early adversity.
- Treatment gap for anxiety disorders is global: Results of the World Mental Health Surveys in 21 countries(2018) ALONSO, Jordi; LIU, Zhaorui; EVANS-LACKO, Sara; SADIKOVA, Ekaterina; SAMPSON, Nancy; CHATTERJI, Somnath; ABDULMALIK, Jibril; AGUILAR-GAXIOLA, Sergio; AL-HAMZAWI, Ali; ANDRADE, Laura H.; BRUFFAERTS, Ronny; CARDOSO, Graca; CIA, Alfredo; FLORESCU, Silvia; GIROLAMO, Giovanni de; GUREJE, Oye; HARO, Josep M.; HE, Yanling; JONGE, Peter de; KARAM, Elie G.; KAWAKAMI, Norito; KOVESS-MASFETY, Viviane; LEE, Sing; LEVINSON, Daphna; MEDINA-MORA, Maria Elena; NAVARRO-MATEU, Fernando; PENNELL, Beth-Ellen; PIAZZA, Marina; POSADA-VILLA, Jose; HAVE, Margreet ten; ZARKOV, Zahari; KESSLER, Ronald C.; THORNICROFT, GrahamBackground: Anxiety disorders are a major cause of burden of disease. Treatment gaps have been described, but a worldwide evaluation is lacking. We estimated, among individuals with a 12-month DSM-IV (where DSM is Diagnostic Statistical Manual) anxiety disorder in 21 countries, the proportion who (i) perceived a need for treatment; (ii) received any treatment; and (iii) received possibly adequate treatment. Methods: Data from 23 community surveys in 21 countries of the World Mental Health (WMH) surveys. DSM-IV mental disorders were assessed (WHO Composite International Diagnostic Interview, CIDI 3.0). DSM-IV included posttraumatic stress disorder among anxiety disorders, while it is not considered so in the DSM-5. We asked if, in the previous 12 months, respondents felt they needed professional treatment and if they obtained professional treatment (specialized/general medical, complementary alternative medical, or nonmedical professional) for ""problems with emotions, nerves, mental health, or use of alcohol or drugs."" Possibly adequate treatment was defined as receiving pharmacotherapy (1+ months of medication and 4+ visits to a medical doctor) or psychotherapy, complementary alternative medicine or nonmedical care (8+ visits). Results: Of 51,547 respondents (response = 71.3%), 9.8% had a 12-month DSM-IV anxiety disorder, 27.6% of whom received any treatment, and only 9.8% received possibly adequate treatment. Of those with 12-month anxiety only 41.3% perceived a need for care. Lower treatment levels were found for lower income countries. Conclusions: Low levels of service use and a high proportion of those receiving services not meeting adequacy standards for anxiety disorders exist worldwide. Results suggest the need for improving recognition of anxiety disorders and the quality of treatment.
- The epidemiology of personality disorders in the Sao Paulo Megacity general population(2018) SANTANA, Geilson Lima; COELHO, Bruno Mendonca; WANG, Yuan-Pang; CHIAVEGATTO FILHO, Alexandre Dias Porto; VIANA, Maria Carmen; ANDRADE, Laura HelenaIntroduction Most studies on the epidemiology of personality disorders (PDs) have been conducted in high-income countries and may not represent what happens in most part of the world. In the last decades, population growth has been concentrated in low-and middle-income countries, with rapid urbanization, increasing inequalities and escalation of violence. Our aim is to estimate the prevalence of PDs in the Sao Paulo Metropolitan Area, one of the largest megacities of the world. We examined sociodemographic correlates, the influence of urban stressors, the comorbidity with other mental disorders, functional impairment and treatment. Methods A representative household sample of 2,942 adults was interviewed using the WHO-Composite International Diagnostic Interview and the International Personality Disorder Examination-Screening Questionnaire. Diagnoses were multiply imputed, and analyses used multivariable regression. Results and discussion Prevalence estimates were 4.3% (Cluster A), 2.7% (Cluster B), 4.6% (Cluster C) and 6.8% (any PD). Cumulative exposure to violence was associated with all PDs except Cluster A, although urbanicity, migration and neighborhood social deprivation were not significant predictors. Comorbidity was the rule, and all clusters were associated with other mental disorders. Lack of treatment is a reality in Greater Sao Paulo, and this is especially true for PDs. With the exception of Cluster C, non-comorbid PDs remained largely untreated in spite of functional impairment independent of other mental disorders. Conclusion Personality disorders are prevalent, clinically significant and undertreated, and public health strategies must address the unmet needs of these subjects. Our results may reflect what happens in other developing world megacities, and future studies are expected in other low- and middle-income countries.
- Major depressive disorder(2018) BROMET, E. J.; ANDRADE, L. H.; BRUFFAERTS, R.; WILLIAMS, D. R.