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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- Treatment Gap of Mental Disorders in Sao Paulo Metropolitan Area, Brazil: Failure and Delay in Initiating Treatment Contact After First Onset of Mental and Substance Use Disorders(2023) FRANCA, Mariane Henriques; WANG, Yuan-Pang; ANDRADE, Laura Helena; VIANA, Maria CarmenAn under-studied crucial step in the health-related help-seeking process is making prompt contact with a treatment provider when a mental disorder strikes. This study aims to provide data on patterns and predictors of failure and delay in making initial treatment contact after the first onset of a mental disorder among adult residents in Sao Paulo, Brazil. A representative face-to-face household survey was conducted among 5,037 respondents aged 18 + years to assess lifetime psychiatric diagnosis, treatment contact, and delay using the World Mental Health Composite International Diagnostic Interview. Cumulative lifetime probability curves show that most people with lifetime disorders eventually make treatment contact, and this is more frequent among those with mood (94.4%) than anxiety (63.6%) and substance use disorders (46.4%). Median delay of treatment contact ranged from 3 to 13 years for mood, 1 to 36 years for anxiety, and 8 to 14 for substance use disorders. Earlier onset was associated with lower probabilities of treatment contact for most disorders (10 out of 15). Failure to promptly seek/receive treatment is a pervasive aspect of the unmet need for mental health care in Brazil.
- The Well-being of Brazilian Industry Workers on Returning to the Physical Workplace During the COVID-19 Pandemic(2023) SANTANA, Geilson Lima; BAPTISTA, Marcos Campello; MATOS, Georgia AntonyGomes de; OGATA, Alberto Jose Niituma; MALIK, Ana Maria; ANDRADE, Laura HelenaObjective: Our aim was to assess the prevalence and predictors of well-being among Brazilian industry workers on returning to the physical workplace during the COVID-19 pandemic.Methods: Two thousand two hundred forty-one participants completed an online survey between October and November 2021. Well-being was assessed with the World Health Organization Well-being Index, and the questionnaire also addressed sociodemographic and occupational characteristics and the health of workers and their contacts. Associations were estimated with logistic regression models.Results: The prevalence of adequate well-being was 63.15%. The predictors of poor well-being included being female, younger, working exclusively from home or on a hybrid model, having comorbid disorders, and living with someone with any comorbidity.Conclusions: The identification of vulnerable groups with poor well-being may help organizations to direct efforts to the unmet psychological needs of these employees and develop well-being programs during this transition.
- Age of onset and cumulative risk of mental disorders: a cross-national analysis of population surveys from 29 countries(2023) MCGRATH, J. J.; AL-HAMZAWI, A.; ALONSO, J.; ALTWAIJRI, Y.; ANDRADE, L. H.; BROMET, E. J.; BRUFFAERTS, R.; ALMEIDA, J. M. C. de; CHARDOUL, S.; CHIU, W. T.; DEGENHARDT, L.; DEMLER, O. V.; FERRY, F.; GUREJE, O.; HARO, J. M.; KARAM, E. G.; KARAM, G.; KHALED, S. M.; KOVESS-MASFETY, V.; MAGNO, M.; MEDINA-MORA, M. E.; MOSKALEWICZ, J.; NAVARRO-MATEU, F.; NISHI, D.; PLANA-RIPOLL, O.; POSADA-VILLA, J.; RAPSEY, C.; SAMPSON, N. A.; STAGNARO, J. C.; STEIN, D. J.; HAVE, M. ten; TORRES, Y.; VLADESCU, C.; WOODRUFF, P. W.; ZARKOV, Z.; KESSLER, R. C.; AGUILAR-GAXIOLA, S.; ALTWAIJRI, Y. A.; ATWOLI, L.; BENJET, C.; BUNTING, B.; CALDAS-DE-ALMEIDA, J. M.; CARDOSO, G.; CíA, A. H.; GIROLAMO, G. De; HARRIS, M. G.; HINKOV, H.; HU, C.-Y.; JONGE, P. De; KARAM, A. N.; KAZDIN, A. E.; KAWAKAMI, N.; KESSLER, R. C.; KIEJNA, A.; MCGRATH, J. J.; PIAZZA, M.; SCOTT, K. M.; STEIN, D. J.; VIANA, M. C.; VIGO, D. V.; WILLIAMS, D. R.; WOODRUFF, P.; WOJTYNIAK, B.; XAVIER, M.; ZASLAVSKY, A. M.Background: Information on the frequency and timing of mental disorder onsets across the lifespan is of fundamental importance for public health planning. Broad, cross-national estimates of this information from coordinated general population surveys were last updated in 2007. We aimed to provide updated and improved estimates of age-of-onset distributions, lifetime prevalence, and morbid risk. Methods: In this cross-national analysis, we analysed data from respondents aged 18 years or older to the World Mental Health surveys, a coordinated series of cross-sectional, face-to-face community epidemiological surveys administered between 2001 and 2022. In the surveys, the WHO Composite International Diagnostic Interview, a fully structured psychiatric diagnostic interview, was used to assess age of onset, lifetime prevalence, and morbid risk of 13 DSM-IV mental disorders until age 75 years across surveys by sex. We did not assess ethnicity. The surveys were geographically clustered and weighted to adjust for selection probability, and standard errors of incidence rates and cumulative incidence curves were calculated using the jackknife repeated replications simulation method, taking weighting and geographical clustering of data into account. Findings: We included 156 331 respondents from 32 surveys in 29 countries, including 12 low-income and middle-income countries and 17 high-income countries, and including 85 308 (54·5%) female respondents and 71 023 (45·4%) male respondents. The lifetime prevalence of any mental disorder was 28·6% (95% CI 27·9–29·2) for male respondents and 29·8% (29·2–30·3) for female respondents. Morbid risk of any mental disorder by age 75 years was 46·4% (44·9–47·8) for male respondents and 53·1% (51·9–54·3) for female respondents. Conditional probabilities of first onset peaked at approximately age 15 years, with a median age of onset of 19 years (IQR 14–32) for male respondents and 20 years (12–36) for female respondents. The two most prevalent disorders were alcohol use disorder and major depressive disorder for male respondents and major depressive disorder and specific phobia for female respondents. Interpretation: By age 75 years, approximately half the population can expect to develop one or more of the 13 mental disorders considered in this Article. These disorders typically first emerge in childhood, adolescence, or young adulthood. Services should have the capacity to detect and treat common mental disorders promptly and to optimise care that suits people at these crucial parts of the life course. Funding: None.
- Antidepressant use in low- middle- and high-income countries: a World Mental Health Surveys report(2023) KAZDIN, Alan E.; WU, Chi-Shin; HWANG, Irving; PUAC-POLANCO, Victor; SAMPSON, Nancy A.; AL-HAMZAWI, Ali; ALONSO, Jordi; ANDRADE, Laura Helena; BENJET, Corina; CALDAS-DE-ALMEIDA, Jose-Miguel; GIROLAMO, Giovanni de; JONGE, Peter de; FLORESCU, Silvia; GUREJE, Oye; HARO, Josep M.; HARRIS, Meredith G.; KARAM, Elie G.; KARAM, Georges; KOVESS-MASFETY, Viviane; LEE, Sing; MCGRATH, John J.; NAVARRO-MATEU, Fernando; NISHI, Daisuke; OLADEJI, Bibilola D.; POSADA-VILLA, Jose; STEIN, Dan J.; USTUN, T. Bedirhan; VIGO, Daniel V.; ZARKOV, Zahari; ZASLAVSKY, Alan M.; KESSLER, Ronald C.Background The most common treatment for major depressive disorder (MDD) is antidepressant medication (ADM). Results are reported on frequency of ADM use, reasons for use, and perceived effectiveness of use in general population surveys across 20 countries. Methods Face-to-face interviews with community samples totaling n = 49 919 respondents in the World Health Organization (WHO) World Mental Health (WMH) Surveys asked about ADM use anytime in the prior 12 months in conjunction with validated fully structured diagnostic interviews. Treatment questions were administered independently of diagnoses and asked of all respondents. Results 3.1% of respondents reported ADM use within the past 12 months. In high-income countries (HICs), depression (49.2%) and anxiety (36.4%) were the most common reasons for use. In low- and middle-income countries (LMICs), depression (38.4%) and sleep problems (31.9%) were the most common reasons for use. Prevalence of use was 2-4 times as high in HICs as LMICs across all examined diagnoses. Newer ADMs were proportionally used more often in HICs than LMICs. Across all conditions, ADMs were reported as very effective by 58.8% of users and somewhat effective by an additional 28.3% of users, with both proportions higher in LMICs than HICs. Neither ADM class nor reason for use was a significant predictor of perceived effectiveness. Conclusion ADMs are in widespread use and for a variety of conditions including but going beyond depression and anxiety. In a general population sample from multiple LMICs and HICs, ADMs were widely perceived to be either very or somewhat effective by the people who use them.
- Determinants of effective treatment coverage for posttraumatic stress disorder: findings from the World Mental Health Surveys(2023) STEIN, Dan J.; KAZDIN, Alan E.; MUNTHALI, Richard J.; HWANG, Irving; HARRIS, Meredith G.; ALONSO, Jordi; ANDRADE, Laura Helena; BRUFFAERTS, Ronny; CARDOSO, Graca; CHARDOUL, Stephanie; GIROLAMO, Giovanni de; FLORESCU, Silvia; GUREJE, Oye; HARO, Josep Maria; KARAM, Aimee N.; KARAM, Elie G.; KOVESS-MASFETY, Viviane; LEE, Sing; MEDINA-MORA, Maria Elena; NAVARRO-MATEU, Fernando; POSADA-VILLA, Jose; STAGNARO, Juan Carlos; HAVE, Margree ten; SAMPSON, Nancy A.; KESSLER, Ronald C.; VIGO, Daniel V.BackgroundPosttraumatic stress disorder (PTSD) is associated with significant morbidity, but efficacious pharmacotherapy and psychotherapy are available. Data from the World Mental Health Surveys were used to investigate extent and predictors of treatment coverage for PTSD in high-income countries (HICs) as well as in low- and middle-income countries (LMICs).MethodsSeventeen surveys were conducted across 15 countries (9 HICs, 6 LMICs) by the World Health Organization (WHO) World Mental Health Surveys. Of 35,012 respondents, 914 met DSM-IV criteria for 12-month PTSD. Components of treatment coverage analyzed were: (a) any mental health service utilization; (b) adequate pharmacotherapy; (c) adequate psychotherapy; and (d) effective treatment coverage. Regression models investigated predictors of treatment coverage.Results12-month PTSD prevalence in trauma exposed individuals was 1.49 (S.E., 0.08). A total of 43.0% (S.E., 2.2) received any mental health services, with fewer receiving adequate pharmacotherapy (13.5%), adequate psychotherapy (17.2%), or effective treatment coverage (14.4%), and with all components of treatment coverage lower in LMICs than HICs. In a multivariable model having insurance (OR = 2.31, 95 CI 1.17, 4.57) and severity of symptoms (OR = .35, 95% CI 0.18, 0.70) were predictive of effective treatment coverage.ConclusionThere is a clear need to improve pharmacotherapy and psychotherapy coverage for PTSD, particularly in those with mild symptoms, and especially in LMICs. Universal health care insurance can be expected to increase effective treatment coverage and therefore improve outcomes.
- Suicide ideation among Brazilian college students: Relationship with academic factors, mental health, and sexual abuse(2023) ALTAVINI, Camila Siebert; ASCIUTTI, Antonio Paulo Rinaldi; SANTANA, Geilson Lima; SOLIS, Ana Cristina Oliveira; ANDRADE, Laura Helena; OLIVEIRA, Lucio Garcia; ANDRADE, Arthur Guerra; GORENSTEIN, Clarice; WANG, Yuan-PangBackground: Suicide is one of the leading causes of death among youth and its occurrence among college students is a matter of great concern. Challenges of transitional adulting and mental illness increase the likelihood of suicidal cognition in students. The objective of present study was to investigate the prevalence of suicide ideation and associated factors in a representative sample of Brazilian college students (n = 12,245).Methods: Data were drawn from a nationwide survey and further subjected to estimate the prevalence of suicide ideation and its association with socio-demographic and academic characteristics. We performed logistic regression analyses upon a conceptual framework, considering individual and academic factors.Results: The point-prevalence of suicide ideation among college students was 5.9 % (SE = 0.37). In the final regression model, variables associated with the likelihood of suicide ideation were psychopathology, sexual abuse, and academic variables, such as dissatisfaction with the chosen undergraduate course (OR = 1.86; IC95 % 1.43-2.41) and low academic performance (OR = 3.56; IC95 % 1.69-7.48). Having children and religious affiliation were inversely associated with the likelihood of suicide ideation.Limitations: Participants were recruited from state capitals, which limited data generalizability to non-urban college students.Conclusions: The impact of academic life on the mental health of students should be carefully monitored in in-campus pedagogical and health services. Early identification of poor-performance students with social disad-vantages could indicate vulnerable ones who are much in need of psycho-social support.
- Towards measuring effective coverage: critical bottlenecks in quality- and user-adjusted coverage for major depressive disorder in Sao Paulo metropolitan area, Brazil(2023) FRANCA, Mariane Henriques; BHARAT, Chrianna; NOVELLO, Ercole; HWANG, Irving; MEDINA-MORA, Maria Elena; BENJET, Corina; ANDRADE, Laura Helena; VIGO, Daniel V.; VIANA, Maria CarmenBackgroundMajor depressive disorder (MDD) contributes to a significant proportion of disease burden, disability, economic losses, and impact on need of treatment and health care in Brazil, but systematic information about its treatment coverage is scarce. This paper aims to estimate the gap in treatment coverage for MDD and identify key bottlenecks in obtaining adequate treatment among adult residents in the Sao Paulo Metropolitan area, Brazil.MethodsA representative face-to-face household survey was conducted among 2942 respondents aged 18+ years to assess 12-month MDD, characteristics of 12-month treatment received, and bottlenecks to deliver care through the World Mental Health Composite International Diagnostic Interview.ResultsAmong those with MDD (n = 491), 164 (33.3% [SE, 1.9]) were seen in health services, with an overall 66.7% treatment gap, and only 25.2% [SE, 4.2] received effective treatment coverage, which represents 8.5% of those in need, with a 91.5% gap in adequate care (66.4% due to lack of utilization and 25.1% due to inadequate quality and adherence). Critical service bottlenecks identified were: use of psychotropic medication (12.2 percentage points drop), use of antidepressants (6.5), adequate medication control (6.8), receiving psychotherapy (19.8).ConclusionsThis is the first study demonstrating the huge treatment gaps for MDD in Brazil, considering not only overall coverage, but also identifying specific quality- and user-adjusted bottlenecks in delivering pharmacological and psychotherapeutic care. These results call for urgent combined actions focused in reducing effective treatment gaps within services utilization, as well as in reducing gaps in availability and accessibility of services, and acceptability of care for those in need.