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 1852 Citação(ões) na Scopus
    Prevalence and Correlates of Bipolar Spectrum Disorder in the World Mental Health Survey Initiative
    (2011) MERIKANGAS, Kathleen R.; JIN, Robert; HE, Jian-Ping; KESSLER, Ronald C.; LEE, Sing; SAMPSON, Nancy A.; VIANA, Maria Carmen; ANDRADE, Laura Helena; HU, Chiyi; KARAM, Elie G.; LADEA, Maria; MEDINA-MORA, Maria Elena; ONO, Yutaka; POSADA-VILLA, Jose; SAGAR, Rajesh; WELLS, J. Elisabeth; ZARKOV, Zahari
    Context: There is limited information on the prevalence and correlates of bipolar spectrum disorder in international population-based studies using common methods. Objectives: To describe the prevalence, impact, patterns of comorbidity, and patterns of service utilization for bipolar spectrum disorder (BPS) in the World Health Organization World Mental Health Survey Initiative. Design, Setting, and Participants: Crosssectional, face-to-face, household surveys of 61 392 community adults in 11 countries in the Americas, Europe, and Asia assessed with the World Mental Health version of the World Health Organization Composite International Diagnostic Interview, version 3.0, a fully structured, lay-administered psychiatric diagnostic interview. Main Outcome Measures: Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) disorders, severity, and treatment. Results: The aggregate lifetime prevalences were 0.6% for bipolar type I disorder (BP-I), 0.4% for BP-II, 1.4% for subthreshold BP, and 2.4% for BPS. Twelve-month prevalences were 0.4% for BP-I, 0.3% for BP-II, 0.8% for subthreshold BP, and 1.5% for BPS. Severity of both manic and depressive symptoms as well as suicidal behavior increased monotonically from subthreshold BP to BP-I. By contrast, role impairment was similar across BP subtypes. Symptom severity was greater for depressive episodes than manic episodes, with approximately 74.0% of respondents with depression and 50.9% of respondents with mania reporting severe role impairment. Three-quarters of those with BPS met criteria for at least 1 other disorder, with anxiety disorders (particularly panic attacks) being the most common comorbid condition. Less than half of those with lifetime BPS received mental health treatment, particularly in low-income countries, where only 25.2% reported contact with the mental health system. Conclusions: Despite cross-site variation in the prevalence rates of BPS, the severity, impact, and patterns of comorbidity were remarkably similar internationally. The uniform increases in clinical correlates, suicidal behavior, and comorbidity across each diagnostic category provide evidence for the validity of the concept of BPS. Treatment needs for BPS are often unmet, particularly in low-income countries.
  • article
    Changes needed in the classification of depressive disorders: options for ICD-11
    (2012) PAYKEL, Eugene; ANDRADE, Laura H.; NJENGA, Frank; PHILLIPS, Michael R.
    This paper considers changes required to the classification of non-bipolar depressive disorders in ICD-11, using ICD-10 as a starting point. The new classification needs to recognize recent epidemiological findings, cross-cultural variations in presentation of depression and differences in provision of health care among WHO Member States. Recommended changes in organization include making the main distinction between bipolar and unipolar disorders, and use of only one overall depressive episode diagnosis, with the distinction between first and recurrent episode to become a subtype or be abandoned. Some redrafting of the criteria for depressive episode is suggested, in order to simplify. Subtypes are discussed, with possible addition of two subtypes (seasonal affective disorder and postpartum depression) and an improved way of handling mixed anxiety-depressive disorders.
  • 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 35 Citação(ões) na Scopus
    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.
  • article 2 Citação(ões) na Scopus
    Determinants of effective treatment coverage for major depressive disorder in the WHO World Mental Health Surveys
    (2022) VIGO, Daniel V.; KAZDIN, Alan E.; SAMPSON, Nancy A.; HWANG, Irving; ALONSO, Jordi; ANDRADE, Laura Helena; AYINDE, Olatunde; BORGES, Guilherme; BRUFFAERTS, Ronny; BUNTING, Brendan; GIROLAMO, Giovanni de; FLORESCU, Silvia; GUREJE, Oye; HARO, Josep Maria; HARRIS, Meredith G.; KARAM, Elie G.; KARAM, Georges; KOVESS-MASFETY, Viviane; LEE, Sing; NAVARRO-MATEU, Fernando; POSADA-VILLA, Jose; SCOTT, Kate; STAGNARO, Juan Carlos; HAVE, Margreet ten; WU, Chi-Shin; XAVIER, Miguel; KESSLER, Ronald C.
    Background Most individuals with major depressive disorder (MDD) receive either no care or inadequate care. The aims of this study is to investigate potential determinants of effective treatment coverage. Methods In order to examine obstacles to providing or receiving care, the type of care received, and the quality and use of that care in a representative sample of individuals with MDD, we analyzed data from 17 WHO World Mental Health Surveys conducted in 15 countries (9 high-income and 6 low/middle-income). Of 35,012 respondents, 3341 had 12-month MDD. We explored the association of socio-economic and demographic characteristics, insurance, and severity with effective treatment coverage and its components, including type of treatment, adequacy of treatment, dose, and adherence. Results High level of education (OR = 1.63; 1.19, 2.24), private insurance (OR = 1.62; 1.06, 2.48), and age (30-59yrs; OR = 1.58; 1.21, 2.07) predicted effective treatment coverage for depression in a multivariable logistic regression model. Exploratory bivariate models further indicate that education may follow a dose-response relation; that people with severe depression are more likely to receive any services, but less likely to receive adequate services; and that in low and middle-income countries, private insurance (the only significant predictor) increased the likelihood of receiving effective treatment coverage four times. Conclusions In the regression models, specific social determinants predicted effective coverage for major depression. Knowing the factors that determine who does and does not receive treatment contributes to improve our understanding of unmet needs and our ability to develop targeted interventions.
  • article 2 Citação(ões) na Scopus
    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 Carmen
    An 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.
  • article 19 Citação(ões) na Scopus
    Patterns and correlates of patient-reported helpfulness of treatment for common mental and substance use disorders in the WHO World Mental Health Surveys
    (2022) KESSLER, Ronald C.; KAZDIN, Alan E.; AGUILAR-GAXIOLA, Sergio; AL-HAMZAWI, Ali; ALONSO, Jordi; ALTWAIJRI, Yasmin A.; ANDRADE, Laura H.; BENJET, Corina; BHARAT, Chrianna; BORGES, Guilherme; BRUFFAERTS, Ronny; BUNTING, Brendan; ALMEIDA, Jose Miguel Caldas; CARDOSO, Graca; CHIU, Wai Tat; CIA, Alfredo; CIUTAN, Marius; DEGENHARDT, Louisa; GIROLAMO, Giovanni; JONGE, Peter; VRIES, Ymkje Anna; FLORESCU, Silvia; GUREJE, Oye; HARO, Josep Maria; HARRIS, Meredith G.; HU, Chiyi; KARAM, Aimee N.; KARAM, Elie G.; KARAM, Georges; KAWAKAMI, Norito; KIEJNA, Andrzej; KOVESS-MASFETY, Viviane; LEE, Sing; MAKANJUOLA, Victor; MCGRATH, John J.; MEDINA-MORA, Maria Elena; MOSKALEWICZ, Jacek; NAVARRO-MATEU, Fernando; NIERENBERG, Andrew A.; NISHI, Daisuke; OJAGBEMI, Akin; OLADEJI, Bibilola D.; O'NEILL, Siobhan; POSADA-VILLA, Jose; PUAC-POLANCO, Victor; RAPSEY, Charlene; RUSCIO, Ayelet Meron; SAMPSON, Nancy A.; SCOTT, Kate M.; SLADE, Tim; STAGNARO, Juan Carlos; STEIN, Dan J.; TACHIMORI, Hisateru; HAVE, Margreet; TORRES, Yolanda; VIANA, Maria Carmen; VIGO, Daniel V.; WILLIAMS, David R.; WOJTYNIAK, Bogdan; XAVIER, Miguel; ZARKOV, Zahari; ZIOBROWSKI, Hannah N.
    Patient-reported helpfulness of treatment is an important indicator of quality in patient-centered care. We examined its pathways and predictors among respondents to household surveys who reported ever receiving treatment for major depression, generalized anxiety disorder, social phobia, specific phobia, post-traumatic stress disorder, bipolar disorder, or alcohol use disorder. Data came from 30 community epidemiological surveys - 17 in high-income countries (HICs) and 13 in low- and middle-income countries (LMICs) - carried out as part of the World Health Organization (WHO)'s World Mental Health (WMH) Surveys. Respondents were asked whether treatment of each disorder was ever helpful and, if so, the number of professionals seen before receiving helpful treatment. Across all surveys and diagnostic categories, 26.1% of patients (N=10,035) reported being helped by the very first professional they saw. Persisting to a second professional after a first unhelpful treatment brought the cumulative probability of receiving helpful treatment to 51.2%. If patients persisted with up through eight professionals, the cumulative probability rose to 90.6%. However, only an estimated 22.8% of patients would have persisted in seeing these many professionals after repeatedly receiving treatments they considered not helpful. Although the proportion of individuals with disorders who sought treatment was higher and they were more persistent in HICs than LMICs, proportional helpfulness among treated cases was no different between HICs and LMICs. A wide range of predictors of perceived treatment helpfulness were found, some of them consistent across diagnostic categories and others unique to specific disorders. These results provide novel information about patient evaluations of treatment across diagnoses and countries varying in income level, and suggest that a critical issue in improving the quality of care for mental disorders should be fostering persistence in professional help-seeking if earlier treatments are not helpful.
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  • article 0 Citação(ões) na Scopus
    Correlates and prevalence of post-traumatic stress disorders in the Sa tilde o Paulo metropolitan area, Brazil
    (2022) COELHO, Bruno Mendonca; SANTANA, Geilson Lima; DANTAS, Heloisa de Souza; VIANA, Maria Carmen; ANDRADE, Laura Helena; WANG, Yuan-Pang
    Background: Post-traumatic stress disorder (PTSD) is a debilitating condition, which generates an extensive burden. We aimed to investigate in a huge metropolitan area, the prevalence of traumatic experiences, the development of PTSD, and its predictors. Methods: Traumatic experiences and PTSD were assessed in 5037 adult individuals of the general population. Cross-tabulations method assessed the prevalence of traumatic events and PTSD. Logistic regression models investigated predictors of lifetime and 12-month odds of PTSD and the conditional probability of developing PTSD for specific traumas. Results: Lifetime and 12-month diagnoses of PTSD were found in 3.2% and 1.6% of the sample. 'Witnessing anyone being injured or killed, or unexpectedly seeing a dead body' (35,7%) and 'being mugged or threatened with a weapon' (34.0%) were the two most reported traumas. The commonest events before PTSD onset were 'sudden unexpected death of a loved one' (34.0%), 'interpersonal violence' (31.0%), and 'threats to the physical integrity of others' (25.0%). Experiences related to ""interpersonal violence "" presented the highest conditional probability for PTSD (range 2.2-21.2%). Being 'sexually assaulted or molested' (21.2% total; 22.3% women; 0.0% men) and being 'raped' (18.8% total; 18.4% women; 20.1% men) were the two experiences with the highest odds for PTSD. While being female was a predictor of less exposure to any event (OR = 0.69), females were more prone to develop lifetime PTSD after exposure to an event (OR = 2.38). Conclusion: Traumatic events are frequent in the general population and a small group of traumatic events accounts for most cases of subsequent PTSD.
  • article 1 Citação(ões) na Scopus
    Suspension of social welfare services and mental health outcomes for women during the COVID-19 pandemic in a peripheral neighborhood in Sao Paulo, Brazil
    (2022) BRUHN, Lenora; SZABZON, Felipe; BROWN, Cristobal Abarca; CABRINI, Daniela Ravelli; MIRANDA, Elisangela; ANDRADE, Laura Helena
    During the COVID-19 pandemic, Brazilian urban peripheries have been severely affected both by the spread of the virus and by social, political, and economical dynamics, raising concerns about the psychological wellbeing and mental health of the population living in these areas. The pandemic broke out in a context of reduced public spending in social and health policies as well as in a process of erosion of social rights, fostering processes of exclusion and highlighting the association between austerity, the increase in poverty and inequality as well as in health and mental health problems indicators. This article presents the results of a qualitative participatory research that investigated subjective experiences in a peripheral neighborhood of Sao Paulo, Brazil, aiming to understand how contextual dynamics played a role in shaping mental health experiences during the COVID-19 pandemic. A multidisciplinary team of researchers worked closely with local volunteers trained to provide emotional support calls to neighbors of the community who signed up for the project. This article presents three ethnographic cases of women who had their routines strongly affected by the suspension of public and social protection services for the containment of the SARS-CoV-2 pandemic, leading to psychological suffering due to the increased demand of ""domestic circuits of care"". We argue that within a context of austerity, the pandemic was remarkably harsh in urban peripheries and, specifically, for women with caring responsibilities. In addition to highlighting the pervasive ""social protection gap"", the cases presented in this paper also reveals the unequal dynamics of the social reproduction work in several layers, which falls mainly on women's shoulders. The ""crisis of care"", proposed by gender and feminist scholars, can contribute to understanding the psychological outcomes of the COVID-19 pandemic for these women.