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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- Twelve-month mental health service use in six countries of the Americas: A regional report from the World Mental Health Surveys(2020) BORGES, G.; AGUILAR-GAXIOLA, S.; ANDRADE, L.; BENJET, C.; CIA, A.; KESSLER, R. C.; OROZCO, R.; SAMPSON, N.; STAGNARO, J. C.; TORRES, Y.; VIANA, Maria Carmen; MEDINA-MORA, M. E.Aims. To provide cross-national data for selected countries of the Americas on service utilization for psychiatric and substance use disorders, the distribution of these services among treatment sectors, treatment adequacy and factors associated with mental health treatment and adequacy of treatment. Methods. Data come from data collected from 6710 adults with 12 month mental disorder surveys across seven surveys in six countries in North (USA), Central (Mexico) and South (Argentina, Brazil, Colombia, Peru) America who were interviewed 2001-2015 as part of the World Health Organization (WHO) World Mental Health (WMH) Surveys. DSM-IV diagnoses were made with the WHO Composite International Diagnostic Interview (CIDI). Interviews also assessed service utilization by the treatment sector, adequacy of treatment received and socio-demographic correlates of treatment. Results. Little over one in four of respondents with any 12 month DSM-IV/CIDI disorder received any treatment. Although the vast majority (87.1%) of this treatment was minimally adequate, only 35.3% of cases received treatment that met acceptable quality guidelines. Indicators of social-advantage (high education and income) were associated with higher rates of service use and adequacy, but a number of other correlates varied across survey sites. Conclusions. These results shed light on an enormous public health problem involving under-treatment of common mental disorders, although the problem is most extreme among people with social disadvantage. Promoting services that are more accessible, especially for those with few resources, is urgently needed.
article Somatization in Latin America: a review on the classification of somatoform disorders, functional syndromes, and medically unexplained symptoms(2011) TOFOLI, Luis Fernando; ANDRADE, Laura Helena; FORTES, SandraObjective: medically unexplained symptoms are common and associated with mental illness in various contexts. Previous studies show that Latin American populations are prone to somatization. Given the reformulation of the International Classification of Diseases towards its 11(th) edition the peculiarities of the population from this region of the world shall be taken into consideration. The objective of this study is to provide information on somatization in Latin American populations to help the decision making about medically unexplained symptoms diagnostic categories in the 11(th) edition of the International Classification of Diseases. Method: Extensive review of the academic production from 1995 to 2011 on somatization in populations of Latin American origin. Results: The analysis of 106 studies included in this review was divided into 15 categories: systematic reviews, conceptual reviews, prevalence, primary care, depression and anxiety, risk factors, violence, organic conditions, relationship with health care, ethnicity, culture-bound syndromes, chronic fatigue syndrome, fibromyalgia, body dysmorphic disorder, and conversion and dissociation. Conclusion: The Latin American studies confirm the difficulty in defining medically unexplained symptoms categories. The supposed ""somatizing trace"" of Latin cultures may be linked more to cultural and linguistic expression than to an ethnic nature, and these peculiarities must be on the agenda for the new classification of these phenomena in the Classification of Diseases-11th edition.- Drinking Patterns and Alcohol Use Disorders in Sao Paulo, Brazil: The Role of Neighborhood Social Deprivation and Socioeconomic Status(2014) SILVEIRA, Camila Magalhaes; SIU, Erica Rosanna; ANTHONY, James C.; SAITO, Luis Paulo; ANDRADE, Arthur Guerra de; KUTSCHENKO, Andressa; VIANA, Maria Carmen; WANG, Yuan-Pang; MARTINS, Silvia S.; ANDRADE, Laura HelenaBackground: Research conducted in high-income countries has investigated influences of socioeconomic inequalities on drinking outcomes such as alcohol use disorders (AUD), however, associations between area-level neighborhood social deprivation (NSD) and individual socioeconomic status with these outcomes have not been explored in Brazil. Thus, we investigated the role of these factors on drink-related outcomes in a Brazilian population, attending to male-female variations. Methods: A multi-stage area probability sample of adult household residents in the Sao Paulo Metropolitan Area was assessed using the WHO Composite International Diagnostic Interview (WMH-CIDI) (n = 5,037). Estimation focused on prevalence and correlates of past-year alcohol disturbances [heavy drinking of lower frequency (HDLF), heavy drinking of higher frequency (HDHF), abuse, dependence, and DMS-5 AUD] among regular users (RU); odds ratio (OR) were obtained. Results: Higher NSD, measured as an area-level variable with individual level variables held constant, showed an excess odds for most alcohol disturbances analyzed. Prevalence estimates for HDLF and HDHF among RU were 9% and 20%, respectively, with excess odds in higher NSD areas; schooling (inverse association) and low income were associated with male HDLF. The only individual-level association with female HDLF involved employment status. Prevalence estimates for abuse, dependence, and DSM-5 AUD among RU were 8%, 4%, and 8%, respectively, with excess odds of: dependence in higher NSD areas for males; abuse and AUD for females. Among RU, AUD was associated with unemployment, and low education with dependence and AUD. Conclusions: Regular alcohol users with alcohol-related disturbances are more likely to be found where area-level neighborhood characteristics reflect social disadvantage. Although we cannot draw inferences about causal influence, the associations are strong enough to warrant future longitudinal alcohol studies to explore causal mechanisms related to the heterogeneous patterns of association and male-female variations observed herein. Hopefully, these findings may help guide future directions for public health.
- Gender differences in drinking patterns and alcohol-related problems in a community sample in Sao Paulo, Brazil(2012) SILVEIRA, Camila Magalhaes; SIU, Erica Rosanna; WANG, Yuan-Pang; VIANA, Maria Carmen; ANDRADE, Arthur Guerra de; ANDRADE, Laura HelenaOBJECTIVE: To investigate drinking patterns and gender differences in alcohol-related problems in a Brazilian population, with an emphasis on the frequency of heavy drinking. METHODS: A cross-sectional study was conducted with a probability adult household sample (n = 1,464) in the city of Sao Paulo, Brazil. Alcohol intake and ICD-10 psychopathology diagnoses were assessed with the Composite International Diagnostic Interview 1.1. The analyses focused on the prevalence and determinants of 12-month non-heavy drinking, heavy episodic drinking (4-5 drinks per occasion), and heavy and frequent drinking (heavy drinking at least 3 times/week), as well as associated alcohol-related problems according to drinking patterns and gender. RESULTS: Nearly 22% (32.4% women, 8.7% men) of the subjects were lifetime abstainers, 60.3% were non-heavy drinkers, and 17.5% reported heavy drinking in a 12-month period (26.3% men, 10.9% women). Subjects with the highest frequency of heavy drinking reported the most problems. Among subjects who did not engage in heavy drinking, men reported more problems than did women. A gender convergence in the amount of problems was observed when considering heavy drinking patterns. Heavy and frequent drinkers were twice as likely as abstainers to present lifetime depressive disorders. Lifetime nicotine dependence was associated with all drinking patterns. Heavy and frequent drinking was not restricted to young ages. CONCLUSIONS: Heavy and frequent episodic drinking was strongly associated with problems in a community sample from the largest city in Latin America. Prevention policies should target this drinking pattern, independent of age or gender. These findings warrant continued research on risky drinking behavior, particularly among persistent heavy drinkers at the non-dependent level.
- 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, BogdanBackgroundSpecific 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.
- Disability Mediates the Impact of Common Conditions on Perceived Health(2013) ALONSO, Jordi; VILAGUT, Gemma; ADROHER, Nuria D.; CHATTERJI, Somnath; HE, Yanling; ANDRADE, Laura Helena; BROMET, Evelyn; BRUFFAERTS, Ronny; FAYYAD, John; FLORESCU, Silvia; GIROLAMO, Giovanni de; GUREJE, Oye; HARO, Josep Maria; HINKOV, Hristo; HU, Chiyi; IWATA, Noboru; LEE, Sing; LEVINSON, Daphna; LEPINE, Jean Pierre; MATSCHINGER, Herbert; MEDINA-MORA, Maria Elena; O'NEILL, Siobhan; HORMEL, J.; POSADA-VILLA, Jose A.; TAIB, Nezar Ismet; XAVIER, Miguel; KESSLER, Ronald C.Background: We examined the extent to which disability mediates the observed associations of common mental and physical conditions with perceived health. Methods and Findings: WHO World Mental Health (WMH) Surveys carried out in 22 countries worldwide (n = 51,344 respondents, 72.0% response rate). We assessed nine common mental conditions with the WHO Composite International Diagnostic Interview (CIDI), and ten chronic physical with a checklist. A visual analog scale (VAS) score (0, worst to 100, best) measured perceived health in the previous 30 days. Disability was assessed using a modified WHO Disability Assessment Schedule (WHODAS), including: cognition, mobility, self-care, getting along, role functioning (life activities), family burden, stigma, and discrimination. Path analysis was used to estimate total effects of conditions on perceived health VAS and their separate direct and indirect (through the WHODAS dimensions) effects. Twelve-month prevalence was 14.4% for any mental and 51.4% for any physical condition. 31.7% of respondents reported difficulties in role functioning, 11.4% in mobility, 8.3% in stigma, 8.1% in family burden and 6.9% in cognition. Other difficulties were much less common. Mean VAS score was 81.0 (SD = 0.1). Decrements in VAS scores were highest for neurological conditions (9.8), depression (8.2) and bipolar disorder (8.1). Across conditions, 36.8% (IQR: 31.2-51.5%) of the total decrement in perceived health associated with the condition were mediated by WHODAS disabilities (significant for 17 of 19 conditions). Role functioning was the dominant mediator for both mental and physical conditions. Stigma and family burden were also important mediators for mental conditions, and mobility for physical conditions. Conclusions: More than a third of the decrement in perceived health associated with common conditions is mediated by disability. Although the decrement is similar for physical and mental conditions, the pattern of mediation is different. Research is needed on the benefits for perceived health of targeted interventions aimed at particular disability dimensions.
- 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-PangBackground: 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.
- Cardiovascular risk factors and major depressive disorder: a cross-sectional study in Sao Paulo, Brazil(2021) BIVANCO-LIMA, Danielle; SANTOS, Itamar de Souza; WANG, Yuan-Pang; VIANA, Maria Carmen; ANDRADE, Laura Helena; LOTUFO, Paulo Andrade; BENSENOR, Isabela Judith MartinsBACKGROUND: Cardiovascular risk factors can mediate the association between depression and cardiovascular diseases. OBJECTIVE: To evaluate cardiovascular risk factors in adult individuals with and without histories of major depression in the metropolitan region of Sao Paulo, Brazil. DESIGN AND SETTING: Cross-sectional study in Sao Paulo (SP), Brazil. METHODS: This study evaluated 423 individuals without any lifetime diagnosis of major depression and 203 individuals with a previous diagnosis of major depression (n = 626). The participants underwent a psychiatric evaluation using a structured clinical interview (SCID-1), an anthropometric evaluation and a clinical evaluation that included blood pressure measurement and assessment of fasting blood glucose, lipid profile and physical activity levels. RESULTS: Individuals with histories of major depression were more likely to be female (P < 0.0001). Individuals with lifetime diagnoses of major depression were more likely to be current smokers (odds ratio, OR 1.61; 95% confidence interval, CI 1.01-2.59) and to have diabetes (OR 1.79; 95% CI 1.01-3.21); and less likely to be obese (OR 0.58; 95% CI 0.35-0.94). CONCLUSION: Individuals with major depression had higher odds of presenting tobacco smoking and diabetes, and lower odds of being obese. Healthcare professionals need to be aware of this, so as to increase the rates of diagnosis and treatment in this population.
- Mental Disorders in Megacities: Findings from the Sao Paulo Megacity Mental Health Survey, Brazil(2012) ANDRADE, Laura Helena; WANG, Yuan-Pang; ANDREONI, Solange; SILVEIRA, Camila Magalhaes; ALEXANDRINO-SILVA, Clovis; SIU, Erica Rosanna; NISHIMURA, Raphael; ANTHONY, James C.; GATTAZ, Wagner Farid; KESSLER, Ronald C.; VIANA, Maria CarmenBackground: World population growth is projected to be concentrated in megacities, with increases in social inequality and urbanization-associated stress. Sao Paulo Metropolitan Area (SPMA) provides a forewarning of the burden of mental disorders in urban settings in developing world. The aim of this study is to estimate prevalence, severity, and treatment of recently active DSM-IV mental disorders. We examined socio-demographic correlates, aspects of urban living such as internal migration, exposure to violence, and neighborhood-level social deprivation with 12-month mental disorders. Methods and Results: A representative cross-sectional household sample of 5,037 adults was interviewed face-to-face using the WHO Composite International Diagnostic Interview (CIDI), to generate diagnoses of DSM-IV mental disorders within 12 months of interview, disorder severity, and treatment. Administrative data on neighborhood social deprivation were gathered. Multiple logistic regression was used to evaluate individual and contextual correlates of disorders, severity, and treatment. Around thirty percent of respondents reported a 12-month disorder, with an even distribution across severity levels. Anxiety disorders were the most common disorders (affecting 19.9%), followed by mood (11%), impulse-control (4.3%), and substance use (3.6%) disorders. Exposure to crime was associated with all four types of disorder. Migrants had low prevalence of all four types compared to stable residents. High urbanicity was associated with impulse-control disorders and high social deprivation with substance use disorders. Vulnerable subgroups were observed: women and migrant men living in most deprived areas. Only one-third of serious cases had received treatment in the previous year. Discussion: Adults living in Sao Paulo megacity had prevalence of mental disorders at greater levels than similar surveys conducted in other areas of the world. Integration of mental health promotion and care into the rapidly expanding Brazilian primary health system should be strengthened. This strategy might become a model for poorly resourced and highly populated developing countries.
- 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.