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 44 Citação(ões) na Scopus
    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, Kate
    BackgroundThe 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.
  • article 140 Citação(ões) na Scopus
    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. de
    Background. 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.
  • article 832 Citação(ões) na Scopus
    Mental disorders among college students in the World Health Organization World Mental Health Surveys
    (2016) 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.
    Background Although mental disorders are significant predictors of educational attainment throughout the entire educational career, most research on mental disorders among students has focused on the primary and secondary school years. Method The World Health Organization World Mental Health Surveys were used to examine the associations of mental disorders with college entry and attrition by comparing college students (n = 1572) and non-students in the same age range (18-22 years; n = 4178), including non-students who recently left college without graduating (n = 702) based on surveys in 21 countries (four low/lower-middle income, five upper-middle-income, one lower-middle or upper-middle at the times of two different surveys, and 11 high income). Lifetime and 12-month prevalence and age-of-onset of DSM-IV anxiety, mood, behavioral and substance disorders were assessed with the Composite International Diagnostic Interview (CIDI). Results One-fifth (20.3%) of college students had 12-month DSM-IV/CIDI disorders; 83.1% of these cases had pre-matriculation onsets. Disorders with pre-matriculation onsets were more important than those with post-matriculation onsets in predicting subsequent college attrition, with substance disorders and, among women, major depression the most important such disorders. Only 16.4% of students with 12-month disorders received any 12-month healthcare treatment for their mental disorders. Conclusions Mental disorders are common among college students, have onsets that mostly occur prior to college entry, in the case of pre-matriculation disorders are associated with college attrition, and are typically untreated. Detection and effective treatment of these disorders early in the college career might reduce attrition and improve educational and psychosocial functioning.
  • article 12 Citação(ões) na Scopus
    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.
  • article 14 Citação(ões) na Scopus
    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.
  • article 56 Citação(ões) na Scopus
    Cross-national differences in the prevalence and correlates of burden among older family caregivers in the World Health Organization World Mental Health (WMH) Surveys
    (2013) SHAHLY, V.; CHATTERJI, S.; GRUBER, M. J.; AL-HAMZAWI, A.; ALONSO, J.; ANDRADE, L. H.; ANGERMEYER, M. C.; BRUFFAERTS, R.; BUNTING, B.; CALDAS-DE-ALMEIDA, J. M.; GIROLAMO, G. de; JONGE, P. de; FLORESCU, S.; GUREJE, O.; HARO, J. M.; HINKOV, H. R.; HU, C.; KARAM, E. G.; LEPINE, J. -P.; LEVINSON, D.; MEDINA-MORA, M. E.; POSADA-VILLA, J.; SAMPSON, N. A.; TRIVEDI, J. K.; VIANA, M. C.; KESSLER, R. C.
    Background. Current trends in population aging affect both recipients and providers of informal family caregiving, as the pool of family caregivers is shrinking while demand is increasing. Epidemiological research has not yet examined the implications of these trends for burdens experienced by aging family caregivers. Method. Cross-sectional community surveys in 20 countries asked 13 892 respondents aged 50+ years about the objective (time, financial) and subjective (distress, embarrassment) burdens they experience in providing care to first-degree relatives with 12 broadly defined serious physical and mental conditions. Differential burden was examined by country income category, kinship status and type of condition. Results. Among the 26.9-42.5% respondents in high-, upper-middle-, and low-/lower-middle-income countries reporting serious relative health conditions, 35.7-42.5% reported burden. Of those, 25.2-29.0% spent time and 13.5-19.4% money, while 24.4-30.6% felt distress and 6.4-21.7% embarrassment. Mean caregiving hours per week in those giving any time were 16.6-23.6 (169.9-205.8 h/week per 100 people aged 50+ years). Burden in low-/lower-middle-income countries was 2- to 3-fold higher than in higher-income countries, with any financial burden averaging 14.3% of median family income in high-, 17.7% in upper-middle-, and 39.8% in low-/lower-middle-income countries. Higher burden was reported by women than men and for conditions of spouses and children than parents or siblings. Conclusions. Uncompensated family caregiving is an important societal asset that offsets rising formal healthcare costs. However, the substantial burdens experienced by aging caregivers across multiple family health conditions and geographic regions threaten the continued integrity of their caregiving capacity. Initiatives supporting older family caregivers are consequently needed, especially in low-/lower-middle-income countries.
  • article 18 Citação(ões) na Scopus
    Patterns of care and dropout rates from outpatient mental healthcare in low-, middle- and high-income countries from the World Health Organization's World Mental Health Survey Initiative
    (2021) FERNANDEZ, Daniel; VIGO, Daniel; SAMPSON, Nancy A.; HWANG, Irving; AGUILAR-GAXIOLA, Sergio; AL-HAMZAWI, Ali O.; ALONSO, Jordi; ANDRADE, Laura Helena; BROMET, Evelyn J.; GIROLAMO, Giovanni de; JONGE, Peter de; FLORESCU, Silvia; GUREJE, Oye; HINKOV, Hristo; HU, Chiyi; KARAM, Elie G.; KARAM, Georges; KAWAKAMI, Norito; KIEJNA, Andrzej; KOVESS-MASFETY, Viviane; MEDINA-MORA, Maria E.; NAVARRO-MATEU, Fernando; OJAGBEMI, Akin; O'NEILL, Siobhan; PIAZZA, Marina; POSADA-VILLA, Jose; RAPSEY, Charlene; WILLIAMS, David R.; XAVIER, Miguel; ZIV, Yuval; KESSLER, Ronald C.; HARO, Josep M.
    Background There is a substantial proportion of patients who drop out of treatment before they receive minimally adequate care. They tend to have worse health outcomes than those who complete treatment. Our main goal is to describe the frequency and determinants of dropout from treatment for mental disorders in low-, middle-, and high-income countries. Methods Respondents from 13 low- or middle-income countries (N = 60 224) and 15 in high-income countries (N = 77 303) were screened for mental and substance use disorders. Cross-tabulations were used to examine the distribution of treatment and dropout rates for those who screened positive. The timing of dropout was examined using Kaplan-Meier curves. Predictors of dropout were examined with survival analysis using a logistic link function. Results Dropout rates are high, both in high-income (30%) and low/middle-income (45%) countries. Dropout mostly occurs during the first two visits. It is higher in general medical rather than in specialist settings (nearly 60% v. 20% in lower income settings). It is also higher for mild and moderate than for severe presentations. The lack of financial protection for mental health services is associated with overall increased dropout from care. Conclusions Extending financial protection and coverage for mental disorders may reduce dropout. Efficiency can be improved by managing the milder clinical presentations at the entry point to the mental health system, providing adequate training, support and specialist supervision for non-specialists, and streamlining referral to psychiatrists for more severe cases.
  • article 1 Citação(ões) na Scopus
    Transdiagnostic development of internalizing psychopathology throughout the life course up to age 45: a World Mental Health Surveys report
    (2022) VRIES, Ymkje Anna de; AL-HAMZAWI, Ali; ALONSO, Jordi; ANDRADE, Laura Helena; BENJET, Corina; BRUFFAERTS, Ronny; BUNTING, Brendan; GIROLAMO, Giovanni de; FLORESCU, Silvia; GUREJE, Oye; HARO, Josep Maria; KARAM, Aimee; KARAM, Elie G.; KAWAKAMI, Norito; KOVESS-MASFETY, Viviane; LEE, Sing; MNEIMNEH, Zeina; NAVARRO-MATEU, Fernando; OJAGBEMI, Akin; POSADA-VILLA, Jose; SCOTT, Kate; STAGNARO, Juan Carlos; TORRES, Yolanda; XAVIER, Miguel; ZARKOV, Zahari N.; KESSLER, Ronald C.; JONGE, Peter de
    Background Depressive and anxiety disorders are highly comorbid, which has been theorized to be due to an underlying internalizing vulnerability. We aimed to identify groups of participants with differing vulnerabilities by examining the course of internalizing psychopathology up to age 45. Methods We used data from 24158 participants (aged 45+) in 23 population-based cross-sectional World Mental Health Surveys. Internalizing disorders were assessed with the Composite International Diagnostic Interview (CIDI). We applied latent class growth analysis (LCGA) and investigated the characteristics of identified classes using logistic or linear regression. Results The best-fitting LCGA solution identified eight classes: a healthy class (81.9%), three childhood-onset classes with mild (3.7%), moderate (2.0%), or severe (1.1%) internalizing comorbidity, two puberty-onset classes with mild (4.0%) or moderate (1.4%) comorbidity, and two adult-onset classes with mild comorbidity (2.7% and 3.2%). The childhood-onset severe class had particularly unfavorable sociodemographic outcomes compared to the healthy class, with increased risks of being never or previously married (OR = 2.2 and 2.0, p < 0.001), not being employed (OR = 3.5, p < 0.001), and having a low/low-average income (OR = 2.2, p < 0.001). Moderate or severe (v. mild) comorbidity was associated with 12-month internalizing disorders (OR = 1.9 and 4.8, p < 0.001), disability (B = 1.1-2.3, p < 0.001), and suicidal ideation (OR = 4.2, p < 0.001 for severe comorbidity only). Adult (v. childhood) onset was associated with lower rates of 12-month internalizing disorders (OR = 0.2, p < 0.001). Conclusions We identified eight transdiagnostic trajectories of internalizing psychopathology. Unfavorable outcomes were concentrated in the 1% of participants with childhood onset and severe comorbidity. Early identification of this group may offer opportunities for preventive interventions.
  • article 760 Citação(ões) na Scopus
    Barriers to mental health treatment: results from the WHO World Mental Health surveys
    (2014) ANDRADE, L. H.; ALONSO, J.; MNEIMNEH, Z.; WELLS, J. E.; AL-HAMZAWI, A.; BORGES, G.; BROMET, E.; BRUFFAERTS, R.; GIROLAMO, G. de; GRAAF, R. de; FLORESCU, S.; GUREJE, O.; HINKOV, H. R.; HU, C.; HUANG, Y.; HWANG, I.; JIN, R.; KARAM, E. G.; KOVESS-MASFETY, V.; LEVINSON, D.; MATSCHINGER, H.; O'NEILL, S.; POSADA-VILLA, J.; SAGAR, R.; SAMPSON, N. A.; SASU, C.; STEIN, D. J.; TAKESHIMA, T.; VIANA, M. C.; XAVIER, M.; KESSLER, R. C.
    Background. To examine barriers to initiation and continuation of mental health treatment among individuals with common mental disorders. Method. Data were from the World Health Organization (WHO) World Mental Health (WMH) surveys. Representative household samples were interviewed face to face in 24 countries. Reasons to initiate and continue treatment were examined in a subsample (n=63678) and analyzed at different levels of clinical severity. Results. Among those with a DSM-IV disorder in the past 12 months, low perceived need was the most common reason for not initiating treatment and more common among moderate and mild than severe cases. Women and younger people with disorders were more likely to recognize a need for treatment. A desire to handle the problem on one's own was the most common barrier among respondents with a disorder who perceived a need for treatment (63.8%). Attitudinal barriers were much more important than structural barriers to both initiating and continuing treatment. However, attitudinal barriers dominated for mild-moderate cases and structural barriers for severe cases. Perceived ineffectiveness of treatment was the most commonly reported reason for treatment drop-out (39.3%), followed by negative experiences with treatment providers (26.9% of respondents with severe disorders). Conclusions. Low perceived need and attitudinal barriers are the major barriers to seeking and staying in treatment among individuals with common mental disorders worldwide. Apart from targeting structural barriers, mainly in countries with poor resources, increasing population mental health literacy is an important endeavor worldwide.