LAURA HELENA SILVEIRA GUERRA DE ANDRADE

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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

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  • article 5 Citação(ões) na Scopus
    Estimating Service Needs for Alcohol and Other Drug Users According to a Tiered Framework: The Case of the Sao Paulo, Brazil, Metropolitan Area
    (2019) MOTA, Daniela Cristina Belchior; SILVEIRA, Camila Magalhaes; SIU, Erica; GOMIDE, Henrique Pinto; GUERRA, Laura Helena Andrade; RONZANI, Telmo Mota; RUSH, Brian
    Objective: The purpose of this study was to estimate the need for population-level services for alcohol and other drug abuse in support of local planning. Method: Data were drawn from a subsample of 2,942 interviewees from the Sao Paulo Megacity Study, which evaluated mental health in the general population (18 years and older) of residents in the Sao Paulo metropolitan area. This population was classified into five hierarchical categories of severity, making it possible to obtain estimates of need for services, combining evaluation criteria regarding drug and alcohol use and general and mental health comorbidities over the last 12 months. For the at-risk groups in this population, estimates from the Potential Demand for the Use of Services survey interviews over the last year were generated. Results: Concerning the need for services, 86.5% of the population (Tier 1) had no problems related to drug and alcohol use, 8.9% (Tier 2) used heavily, 3.5% (Tiers 3, 4, and 5) met criteria for substance abuse disorders, among whom 1.3% (Tiers 4 and 5) require more specialized and intensive treatment and support. The following estimates for the Potential Demand for the Use of Services were found: 25.5% (Tier 3) and 51.1% (Tier 4), indicating that a significant number of individuals met criteria for substance abuse disorders but did not perceive any need for professional help or neglected the help available. Conclusions: In Sao Paulo there exists a large sector of the population that requires prevention strategies regarding the risks and harm resulting from alcohol and drug use, followed by a group requiring more specialized care. But a large number of substance users requiring specialized support did not use services and did not believe that they needed professional help.
  • article 24 Citação(ões) na Scopus
    Childhood generalized specific phobia as an early marker of internalizing psychopathology across the lifespan: results from the World Mental Health Surveys
    (2019) VRIES, Ymkje Anna de; AL-HAMZAWI, Ali; ALONSO, Jordi; BORGES, Guilherme; BRUFFAERTS, Ronny; BUNTING, Brendan; CALDAS-DE-ALMEIDA, Jose Miguel; CIA, Alfredo H.; GIROLAMO, Giovanni De; V, Rumyana Dinolova; ESAN, Oluyomi; FLORESCU, Silvia; GUREJE, Oye; HARO, Josep Maria; HU, Chiyi; KARAM, Elie G.; KARAM, Aimee; KAWAKAMI, Norito; KIEJNA, Andrzej; KOVESS-MASFETY, Viviane; LEE, Sing; MNEIMNEH, Zeina; NAVARRO-MATEU, Fernando; PIAZZA, Marina; SCOTT, Kate; HAVE, Margreet ten; TORRES, Yolanda; VIANA, Maria Carmen; KESSLER, Ronald C.; JONGE, Peter de; AGUILAR-GAXIOLA, Sergio; AL-KAISY, Mohammed Salih; ANDRADE, Laura Helena; BENJET, Corina; BROMET, Evelyn J.; ALMEIDA, Jose Miguel Caldas de; CARDOSO, Graca; CHATTERJI, Somnath; DEGENHARDT, Louisa; DEMYTTENAERE, Koen; GIROLAMO, Giovanni de; HINKOV, Hristo; HU, Chi-yi; KARAM, Aimee Nasser; LEPINE, Jean-Pierre; LEVINSON, Daphna; MCGRATH, John; MEDINA-MORA, Maria Elena; MOSKALEWICZ, Jacek; PENNELL, Beth-Ellen; POSADA-VILLA, Jose; SCOTT, Kate M.; SLADE, Tim; STAGNARO, Juan Carlos; STEIN, Dan J.; WHITEFORD, Harvey; WILLIAMS, David R.; WOJTYNIAK, Bogdan
    BackgroundSpecific phobia (SP) is a relatively common disorder associated with high levels of psychiatric comorbidity. Because of its early onset, SP may be a useful early marker of internalizing psychopathology, especially if generalized to multiple situations. This study aimed to evaluate the association of childhood generalized SP with comorbid internalizing disorders.MethodsWe conducted retrospective analyses of the cross-sectional population-based World Mental Health Surveys using the Composite International Diagnostic Interview. Outcomes were lifetime prevalence, age of onset, and persistence of internalizing disorders; past-month disability; lifetime suicidality; and 12-month serious mental illness. Logistic and linear regressions were used to assess the association of these outcomes with the number of subtypes of childhood-onset (<13years) SP.ResultsAmong 123,628 respondents from 25 countries, retrospectively reported prevalence of childhood SP was 5.9%, 56% of whom reported one, 25% two, 10% three, and 8% four or more subtypes. Lifetime prevalence of internalizing disorders increased from 18.2% among those without childhood SP to 46.3% among those with one and 75.6% those with 4+ subtypes (OR=2.4, 95% CI 2.3-2.5, p<0.001). Twelve-month persistence of lifetime internalizing comorbidity at interview increased from 47.9% among those without childhood SP to 59.0% and 79.1% among those with 1 and 4+ subtypes (OR=1.4, 95% CI 1.4-1.5, p<0.001). Respondents with 4+ subtypes also reported significantly more disability (3.5days out of role in the past month) than those without childhood SP (1.1days) or with only 1 subtype (1.8days) (B=0.56, SE 0.06, p<0.001) and a much higher rate of lifetime suicide attempts (16.8%) than those without childhood SP (2.0%) or with only 1 subtype (6.5%) (OR=1.7, 95% CI 1.7-1.8, p<0.001).ConclusionsThis large international study shows that childhood-onset generalized SP is related to adverse outcomes in the internalizing domain throughout the life course. Comorbidity, persistence, and severity of internalizing disorders all increased with the number of childhood SP subtypes. Although our study cannot establish whether SP is causally associated with these poor outcomes or whether other factors, such as a shared underlying vulnerability, explain the association, our findings clearly show that childhood generalized SP identifies an important target group for early intervention.
  • article 23 Citação(ões) na Scopus
    Can Gender and Age Impact on Response Pattern of Depressive Symptoms Among College Students? A Differential Item Functioning Analysis
    (2019) SA JUNIOR, Antonio Reis de; LIEBEL, Graziela; ANDRADE, Arthur Guerra de; ANDRADE, Laura Helena; GORENSTEIN, Clarice; WANG, Yuan-Pang
    Background: Self-reported depressive complaints among college students might indicate different degrees of severity of depressive states. Through the framework of item response theory, we aim to describe the pattern of responses to items of the Beck Depression Inventory-II (BDI-II), in terms of endorsement probability and discrimination along the continuum of depression. Potential differential item functioning of the scale items of the BDI-11 is investigated, by gender and age, to compare across sub-groups of students. Methods: The 21-item BDI-II was cross-sectionally administered to a representative sample of 12,677 Brazilian college students. Reliability was evaluated based on Cronbach's alpha coefficient. Severity (b,) and discrimination (a) parameters of each BDI-II items were calculated through the graded response model. The influence of gender and age were tested for differential item functioning (DIF) within the item response theory-based approach. Results: The BDI-II presented good reliability (alpha = 0.91). Women and younger students significantly presented a higher likelihood of depression (cut-off > 13) than men and older counterparts. In general, participants endorsed more easily cognitive-somatic items than affective items of the scale. ""Guilty feelings,"" ""suicidal thoughts,"" and ""loss of interest in sex"" were the items that most likely indicated depression severity (b >= 3.60). However, all BDI-ll items showed moderate-to-high discrimination (a >= 1.32) for depressive state. While two items were flagged for DIF, ""crying"" and ""loss of interest in sex,"" respectively for gender and age, the global weight of these items on the total score was negligible. Conclusions: Although respondents' gender and age might present influence on response pattern of depressive symptoms, the measures of self-reported symptoms have not inflated severity scores. These findings provide further support to the validity of using BDI-II for assessing depression in academic contexts and highlight the value of considering gender- and age-related common symptoms of depression.
  • article 8 Citação(ões) na Scopus
    Absenteeism and Presenteeism Associated With Common Health Conditions in Brazilian Workers
    (2019) BAPTISTA, Marcos C.; BURTON, Wayne N.; NAHAS, Andressa Kutschenko; WANG, Yuan-Pang; VIANA, Maria Carmen; ANDRADE, Laura Helena
    Background: This study describes the effects of common health conditions associated with absenteeism and presenteeism in a population-based sample of workers in Brazil. Methods: Data were analyzed from the cross-sectional Sao Paulo Megacity Mental Health Survey on 1737 employed residents aged more than 18 years old conducted from 2005 to 2007. Results: Physical diseases and mental disorders are highly prevalent among Brazilian workers. The prevalence of absenteeism was 12.8%, and the prevalence of presenteeism was 14.3%. The condition most commonly associated with work impairment was mood disorder. Conclusions: Improving access to care and increasing detection and management of mental disorders should be a priority in Brazil. Occupational health programs and services can play a key role in increasing the productivity of the Brazilian workforce.
  • article 27 Citação(ões) na Scopus
    Concordance between the diagnostic guidelines for alcohol and cannabis use disorders in the draft ICD-11 and other classification systems: analysis of data from the WHO's World Mental Health Surveys
    (2019) DEGENHARDT, Louisa; BHARAT, Chrianna; BRUNO, Raimondo; GLANTZ, Meyer D.; SAMPSON, Nancy A.; LAGO, Luise; AGUILAR-GAXIOLA, Sergio; ALONSO, Jordi; ANDRADE, Laura Helena; BUNTING, Brendan; CALDAS-DE-ALMEIDA, Jose Miguel; CIA, Alfredo H.; GUREJE, Oye; KARAM, Elie G.; KHALAF, Mohammad; MCGRATH, John J.; MOSKALEWICZ, Jacek; LEE, Sing; MNEIMNEH, Zeina; NAVARRO-MATEU, Fernando; SASU, Carmen C.; SCOTT, Kate; TORRES, Yolanda; POZNYAK, Vladimir; CHATTERJI, Somnath; KESSLER, Ronald C.; AGUILAR-GAXIOLA, Sergio; AL-HAMZAWI, Ali; AL-KAISY, Mohammed Salih; ALONSO, Jordi; BENJET, Corina; BORGES, Guilherme; BROMET, Evelyn J.; BRUFFAERTS, Ronny; BUNTING, Brendan; ALMEIDA, Jose Miguel Caldas de; CARDOSO, Graca; CHATTERJI, Somnath; CIA, Alfredo H.; DEGENHARDT, Louisa; DEMYTTENAERE, Koen; FAYYAD, John; FLORESCU, Silvia; GIROLAMO, Giovanni de; GUREJE, Oye; HARO, Josep Maria; HE, Yanling; HINKOV, Hristo; HU, Chi-yi; HUANG, Yueqin; JONGE, Peter de; KARAM, Aimee Nasser; KARAM, Elie G.; KAWAKAMI, Norito; KESSLER, Ronald C.; KIEJNA, Andrzej; KOVESS-MASFETY, Viviane; LEE, Sing; LEPINE, Jean-Pierre; LEVINSON, Daphna; MCGRATH, John; MEDINA-MORA, Maria Elena; MNEIMNEH, Zeina; MOSKALEWICZ, Jacek; NAVARRO-MATEU, Fernando; PENNELL, Beth-Ellen; PIAZZA, Marina; POSADA-VILLA, Jose; SCOTT, Kate M.; SLADE, Tim; STAGNARO, Juan Carlos; STEIN, Dan J.; HAVE, Margreet ten; TORRES, Yolanda; VIANA, Maria Carmen; WHITEFORD, Harvey; WILLIAMS, David R.; WOJTYNIAK, Bogdan
    Background and aims The World Health Organization's (WHO's) proposed International Classification of Diseases, 11th edition (ICD-11) includes several major revisions to substance use disorder (SUD) diagnoses. It is essential to ensure the consistency of within-subject diagnostic findings throughout countries, languages and cultures. To date, agreement analyses between different SUD diagnostic systems have largely been based in high-income countries and clinical samples rather than general population samples. We aimed to evaluate the prevalence of, and concordance between diagnoses using the ICD-11, The WHO's ICD 10th edition (ICD-10) and the Diagnostic and Statistical Manual of Mental Disorders, 4th and 5th editions (DSM-IV, DSM-5); the prevalence of disaggregated ICD-10 and ICD-11 symptoms; and variation in clinical features across diagnostic groups. Design Cross-sectional household surveys. Setting Representative surveys of the general population in 10 countries (Argentina, Australia, Brazil, Colombia, Iraq, Northern Ireland, Poland, Portugal, Romania and Spain) of the World Mental Health Survey Initiative. Participants Questions about SUDs were asked of 12 182 regular alcohol users and 1788 cannabis users. Measurements Each survey used the World Mental Health Survey Initiative version of the WHO Composite International Diagnostic Interview version 3.0 (WMH-CIDI). Findings Among regular alcohol users, prevalence (95% confidence interval) of life-time ICD-11 alcohol harmful use and dependence were 21.6% (20.5-22.6%) and 7.0% (6.4-7.7%), respectively. Among cannabis users, 9.3% (7.4-11.1%) met criteria for ICD-11 harmful use and 3.2% (2.3-4.0%) for dependence. For both substances, all comparisons of ICD-11 with ICD-10 and DSM-IV showed excellent concordance (all kappa >= 0.9). Concordance between ICD-11 and DSM-5 ranged from good (for SUD and comparisons of dependence and severe SUD) to poor (for comparisons of harmful use and mild SUD). Very low endorsement rates were observed for new ICD-11 feature for harmful use ('harm to others'). Minimal variation in clinical features was observed across diagnostic systems. Conclusions The World Health Organization's proposed International Classification of Diseases, 11th edition (ICD-11) classifications for substance use disorder diagnoses are highly consistent with the ICD 10th edition and the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). Concordance between ICD-11 and the DSM 5th edition (DSM-5) varies, due largely to low levels of agreement for the ICD harmful use and DSM-5 mild use disorder. Diagnostic validity of self-reported 'harm to others' is questionable.
  • article 7 Citação(ões) na Scopus
    The relationship between neighborhood-level socioeconomic characteristics and individual mental disorders in five cities in Latin America: multilevel models from the World Mental Health Surveys
    (2019) SAMPSON, Laura; MARTINS, Silvia S.; YU, Shui; CHIAVEGATTO FILHO, Alexandre Dias Porto; ANDRADE, Laura Helena; VIANA, Maria Carmen; MEDINA-MORA, Maria Elena; BENJET, Corina; TORRES, Yolanda; PIAZZA, Marina; AGUILAR-GAXIOLA, Sergio; CIA, Alfredo H.; STAGNARO, Juan Carlos; ZASLAVSKY, Alan M.; KESSLER, Ronald C.; GALEA, Sandro
    Purpose Our understanding of community-level predictors of individual mental disorders in large urban areas of lower income countries is limited. In particular, the proportion of migrant, unemployed, and poorly educated residents in neighborhoods of these urban areas may characterize group contexts and shape residents' health. Methods Cross-sectional household interviews of 7251 adults were completed across 83 neighborhoods of Buenos Aires, Argentina; Medellin, Colombia; Sao Paulo, Brazil; Lima, Peru; and Mexico City, Mexico as part of the World Mental Health Survey Initiative. Past-year internalizing and externalizing mental disorders were assessed, and multilevel models were used. Results Living in neighborhoods with either an above-average or below-average proportion of migrants and highly educated residents was associated with lower odds of any internalizing disorder (for proportion migrants: OR 0.75, 95% CI 0.62-0.91 for the bottom tertile and OR 0.79, 95% CI 0.67-0.94 for the top tertile compared to the middle tertile; for proportion highly educated: OR 0.76, 95% CI 0.64-0.90 for the bottom tertile and OR 0.58, 95% CI 0.37-0.90 for the top tertile compared to the middle tertile). Living in neighborhoods with an above-average proportion of unemployed individuals was associated with higher odds of having any internalizing disorder (OR 1.49, 95% CI 1.14-1.95 for the top tertile compared to the middle tertile). The proportion of highly educated residents was associated with lower odds of externalizing disorder (OR 0.54, 95% CI 0.31-0.93 for the top tertile compared to the middle tertile). Conclusions The associations of neighborhood-level migration, unemployment, and education with individual-level odds of mental disorders highlight the importance of community context for understanding the burden of mental disorders among residents of rapidly urbanizing global settings.
  • article 21 Citação(ões) na Scopus
    Multilevel Analysis of the Patterns of Physical-Mental Multimorbidity in General Population of Sao Paulo Metropolitan Area, Brazil
    (2019) WANG, Yuan-Pang; NUNES, Bruno P.; COELHO, Bruno M.; SANTANA, Geilson L.; NASCIMENTO, Carla F. do; VIANA, Maria Carmen; BENSENOR, Isabela M.; ANDRADE, Laura H.; CHIAVEGATTO FILHO, Alexandre D. P.
    Chronic diseases are often comorbid and present a weighty burden for communities in the 21st century. The present investigation depicted patterns of multimorbidity in the general population and examined its association with the individual-and area-level factors in an urban sample of non-elderly adults of Brazil. Data were from the cross-sectional Sao Paulo Megacity Mental Health Survey, a stratified multistage area probability sampling investigation. Trained interviewers assessed mental morbidities and asked about physical conditions for 1,571 community-dwelling women and 1,142 men, aged between 18 and 64 years. Principal component analysis depicted patterns of physicalmental multimorbidity, by sex. Following, the patterns of multimorbidity were subjected to multilevel regression analysis, taking into account individual-and area-level variables. Three patterns of clustering were found for women: 'irritable mood and headache', 'chronic diseases and pain', and 'substance use disorders'. Among men, the patterns were: 'chronic pain and respiratory disease', 'psychiatric disorders', and 'chronic diseases'. Multilevel analyses showed associations between multimorbidity patterns and both individual- and area-level determinants. Our findings call for a reformulation of health-care systems worldwide, especially in low-resource countries. Replacing the single-disease framework by multi-disease patterns in health-care settings can improve the ability of general practitioners in the health-care of person-centred needs.
  • article 16 Citação(ões) na Scopus
    Treatment of anxiety disorders in clinical practice: a critical overview of recent systematic evidence
    (2019) MANGOLINI, Vitor Iglesias; ANDRADE, Laura Helena; LOTUFO-NETO, Francisco; WANG, Yuan-Pang
    The aim of this study was to review emerging evidence of novel treatments for anxiety disorders. We searched PubMed and EMBASE for evidence-based therapeutic alternatives for anxiety disorders in adults, covering the past five years. Eligible articles were systematic reviews (with or without meta-analysis), which evaluated treatment effectiveness of either nonbiological or biological interventions for anxiety disorders. Retrieved articles were summarized as an overview. We assessed methods, quality of evidence, and risk of bias of the articles. Nineteen systematic reviews provided information on almost 88 thousand participants, distributed across 811 clinical trials. Regarding the interventions, 11 reviews investigated psychological or nonbiological treatments; 5, pharmacological or biological; and 3, more than one type of active intervention. Computer-delivered psychological interventions were helpful for treating anxiety of low-to-moderate intensity, but the therapist-oriented approaches had greater results. Recommendations for regular exercise, mindfulness, yoga, and safety behaviors were applicable to anxiety. Transcranial magnetic stimulation, medication augmentation, and new pharmacological agents (vortioxetine) presented inconclusive benefits in patients with anxiety disorders who presented partial responses or refractoriness to standard treatment. New treatment options for anxiety disorders should only be provided to the community after a thorough examination of their efficacy.
  • article 24 Citação(ões) na Scopus
    Association of Cohort and Individual Substance Use With Risk of Transitioning to Drug Use, Drug Use Disorder, and Remission From Disorder: Findings From the World Mental Health Surveys
    (2019) DEGENHARDT, Louisa; BHARAT, Chrianna; GLANTZ, Meyer D.; SAMPSON, Nancy A.; AL-HAMZAWI, Ali; ALONSO, Jordi; BUNTING, Brendan; CIA, Alfredo; GIROLAMO, Giovanni de; JONGE, Peter De; DEMYTTENAERE, Koen; GUREJE, Oye; HARO, Josep Maria; HARRIS, Meredith G.; HE, Yanling; HINKOV, Hristo; KARAM, Aimee Nasser; KARAM, Elie G.; KIEJNA, Andrzej; KOVESS-MASFETY, Viviane; LASEBIKAN, Victor; LEE, Sing; LEVINSON, Daphna; MEDINA-MORA, Maria Elena; MNEIMNEH, Zeina; NAVARRO-MATEU, Fernando; PIAZZA, Marina; POSADA-VILLA, Jose; SCOTT, Kate; STEIN, Dan J.; TACHIMORI, Hisateru; TINTLE, Nathan; TORRES, Yolanda; KESSLER, Ronald C.; AGUILAR-GAXIOLA, Sergio; AL-HAMZAWI, Ali; AL-KAISY, Mohammed Salih; ALONSO, Jordi; ANDRADE, Laura Helena; BENJET, Corina; BORGES, Guilherme; BROMET, Evelyn J.; BRUFFAERTS, Ronny; BUNTING, Brendan; ALMEIDA, Jose Miguel Caldas de; CARDOSO, Graca; CHATTERJI, Somnath; CIA, Alfredo H.; DEGENHARDT, Louisa; DEMYTTENAERE, Koen; FAYYAD, John; FLORESCU, Silvia; GIROLAMO, Giovanni de; GUREJE, Oye; HARO, Josep Maria; HINKOV, Hristo; HU, Chi-yi; JONGE, Peter de; KARAM, Aimee Nasser; KARAM, Elie G.; KAWAKAMI, Norito; KESSLER, Ronald C.; KIEJNA, Andrzej; KOVESS-MASFETY, Viviane; LEE, Sing; LEPINE, Jean-Pierre; LEVINSON, Daphna; MCGRATH, John; MEDINA-MORA, Maria Elena; MNEIMNEH, Zeina; MOSKALEWICZ, Jacek; NAVARRO-MATEU, Fernando; PENNELL, Beth-Ellen; PIAZZA, Marina; POSADA-VILLA, Jose; SCOTT, Kate M.; SLADE, Tim; STAGNARO, Juan Carlos; STEIN, Dan J.; HAVE, Margreet ten; TORRES, Yolanda; VIANA, Maria Carmen; WHITEFORD, Harvey; WILLIAMS, David R.; WOJTYNIAK, Bogdan
    ImportanceLimited empirical research has examined the extent to which cohort-level prevalence of substance use is associated with the onset of drug use and transitioning into greater involvement with drug use. ObjectiveTo use cross-national data to examine time-space variation in cohort-level drug use to assess its associations with onset and transitions across stages of drug use, abuse, dependence, and remission. Design, Setting, and ParticipantsThe World Health Organization World Mental Health Surveys carried out cross-sectional general population surveys in 25 countries using a consistent research protocol and assessment instrument. Adults from representative household samples were interviewed face-to-face in the community in relation to drug use disorders. The surveys were conducted between 2001 and 2015. Data analysis was performed from July 2017 to July 2018. Main Outcomes and MeasuresData on timing of onset of lifetime drug use, DSM-IV drug use disorders, and remission from these disorders was assessed using the Composite International Diagnostic Interview. Associations of cohort-level alcohol prevalence and drug use prevalence were examined as factors associated with these transitions. ResultsAmong the 90027 respondents (48.1% [SE, 0.2%] men; mean [SE] age, 42.1 [0.1] years), 1 in 4 (24.8% [SE, 0.2%]) reported either illicit drug use or extramedical use of prescription drugs at some point in their lifetime, but with substantial time-space variation in this prevalence. Among users, 9.1% (SE, 0.2%) met lifetime criteria for abuse, and 5.0% (SE, 0.2%) met criteria for dependence. Individuals who used 2 or more drugs had an increased risk of both abuse (odds ratio, 5.17 [95% CI, 4.66-5.73]; P<.001) and dependence (odds ratio, 5.99 [95% CI, 5.02-7.16]; P<.001) and reduced probability of remission from abuse (odds ratio, 0.86 [95% CI, 0.76-0.98]; P=.02). Birth cohort prevalence of drug use was also significantly associated with both initiation and illicit drug use transitions; for example, after controlling for individuals' experience of substance use and demographics, for each additional 10% of an individual's cohort using alcohol, a person's odds of initiating drug use increased by 28% (odds ratio, 1.28 [95% CI, 1.26-1.31]). Each 10% increase in a cohort's use of drug increased individual risk by 12% (1.12 [95% CI, 1.11-1.14]). Conclusions and RelevanceBirth cohort substance use is associated with drug use involvement beyond the outcomes of individual histories of alcohol and other drug use. This has important implications for understanding pathways into and out of problematic drug use.
  • article 18 Citação(ões) na Scopus
    Associations between neighborhood-level violence and individual mental disorders: Results from the World Mental Health surveys in five Latin American cities
    (2019) BENJET, C.; SAMPSON, L.; YU, S.; KESSLER, R. C.; ZASLAVSKY, A.; EVANS-LACKO, S.; MARTINS, S. S.; ANDRADE, L. H.; AGUILAR-GAXIOLA, S.; CIA, A.; MEDINA-MORA, M. E.; STAGNARO, J. C.; GALVEZ, M. Y. Torres de; VIANA, M. C.; GALEA, S.
    Rapidly urbanizing areas of Latin America experience elevated but unevenly distributed levels of violence. Extensive research suggests that individual exposure to violence is associated with higher odds of both internalizing (anxiety and mood) and externalizing (substance and intermittent explosive) mental disorders. Less research, however, has focused on how neighborhood-level violence, as an indicator of broader neighborhood contexts, might relate to the mental health of residents, independently of an individual's personal exposure. We used multilevel analyses to examine associations of neighborhood-level violence with individual-level past-year mental disorders, controlling for individual-level violence exposure. We used data from 7,251 adults nested in 83 neighborhoods within five large Latin American cities as part of the WHO World Mental Health Surveys. Accounting for individual-level violence exposure, living in neighborhoods with more violence was associated with significantly elevated odds of individual-level internalizing disorders, but not externalizing disorders. Caution should be exercised when making causal inferences regarding the effects of neighborhood-level violence in the absence of experimental interventions. Nevertheless, neighborhood context, including violence, should be considered in the study of mental disorders. These findings are particularly relevant for rapidly urbanizing areas with high levels of violence, such as Latin America.