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 12 Citação(ões) na Scopus
    Dual burden of chronic physical diseases and anxiety/mood disorders among Sao Paulo Megacity Mental Health Survey Sample, Brazil
    (2017) ASKARI, Melanie S.; ANDRADE, Laura Helena; FILHO, Alexandre Chiavegatto; SILVEIRA, Camila Magalhaes; SIU, Erica; WANG, Yuan-Pang; VIANA, Maria Carmen; MARTINS, Silvia S.
    Background: We assessed comorbid associations of 12-month DSM-IV mood/any anxiety disorders with chronic physical conditions within the Sao Paulo (SP) Megacity Mental Health cross-sectional survey of 5037 participants and explored whether strength of comorbid associations were modified when controlling for demographics. Methods: Chi-square tests and logistic regressions were used to examine comorbid associations of DSM-IV mood/anxiety disorders as measured by the WHO Composite International Diagnostic Interview (CIDI 3.0), and self-reported chronic physical conditions among adults from the SP Megacity Mental Health Survey. Results: Among those with any mood or anxiety disorder, chronic pain disorder was the most common physical condition (48.9% and 44.9%, respectively). Significant unadjusted odds ratios (OR) of comorbidity were found between diagnosis of two or more physical conditions and any mood disorders (3.08, 95% CI: 2.27-4.17), and any anxiety disorders (2.49, 95% CI: 1.95-3.17). Comorbidities remained significant when stratified by gender and controlling for marital status, household income, and education (latter two only included within anxiety models). Limitations: These results cannot be generalized to other cities or rural populations. Homeless and institutionalized populations were not surveyed. Due to cross-sectional study design, the direction of association between chronic disease/chronic disease risk factors and mood disorders is unclear. Conclusions: Dual burden of chronic physical conditions and mood/anxiety disorders is a notable problem among the Sao Paulo Megacity Survey population, with enhanced comorbidity experienced by community members with multiple physical conditions. Clinicians should consider these findings in understanding healthcare delivery for individuals suffering from both psychiatric disorders and chronic physical conditions.
  • 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 5 Citação(ões) na Scopus
    Individual and population level estimates of work loss and related economic costs due to mental and substance use disorders in Metropolitan Sao Paulo, Brazil
    (2022) FRANCA, Mariane Henriques; PEREIRA, Flavia Garcia; WANG, Yuan-Pang; ANDRADE, Laura Helena; ALONSO, Jordi; VIANA, Maria Carmen
    Background: We estimate work loss and economic costs due to mental and substance use disorders in the economically active population of the Sao Paulo Metropolitan Area, Brazil. Methods: The Sao Paulo Megacity Mental Health Survey assessed a population-based sample of 3,007 economically active residents using the Composite International Diagnostic Interview 3.0 and the World Health Organization Disability Assessment Schedule 2 to investigate, respectively, 12-month psychiatric disorders, work performance, and economic costs. Results: Absenteeism over the past 12 months was reported by 12.6%, and presenteeism by 14.7% (qualitative loss) and 13.1% (quantitative loss). Having any mental disorder was associated with 17.6 days of absenteeism and 37.7 days of reduced-qualitative and/or quantitative functioning. Fourteen mental disorders were significantly associated with work loss, with odds ratios ranging from 2.3 for adult separation anxiety to 40.4 for oppositional defiant disorder. At a population-level, oppositional defiant disorder, panic disorder, attention deficit disorder, and dysthymia contributed to the largest costs. The total annual economic costs were USD $83.2 billion/year, representing 6.1% of Brazil's Gross Domestic Product in 2007. Limitations: Diagnosis of mental disorders was based on self-reported symptoms. Work loss assessment was restricted to 30 days before the interview and may not fully represents the annual real experience and symptoms of the respondents which would lead to an overestimation of the burden. Conclusions: Mental disorders impose a great negative impact on work performance and functioning, with a consequent high economic burden, pointing to the need of implementing cost-effective interventions to prevent work loss.
  • 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 16 Citação(ões) na Scopus
    Use of psychotropic medications in Sao Paulo Metropolitan Area, Brazil: pattern of healthcare provision to general population
    (2015) CAMPANHA, Angela Maria; SIU, Erica Rosanna; MILHORANCA, Igor Andre; VIANA, Maria Carmen; WANG, Yuan-Pang; ANDRADE, Laura Helena
    Purpose We estimate the proportion of psychotropic medication use (PMU) among adults in Sao Paulo Metropolitan Area, Brazil. We investigated whether socio-demographic factors, comorbidity, and disease severity influence PMU among individuals with psychiatric disorders. Methods Data are from the Sao Paulo Megacity Mental Health Survey, a cross-sectional, population-based study, the Brazilian branch of the World Mental Health Survey Initiative. Trained lay interviewers face-to-face assessed psychiatric disorders and PMU through the Composite International Diagnostic Interview. Respondents were asked about use of healthcare service and prescribed medications for mental disorders in the previous year. Information on PMU was collected for 2935 adult residents in the area and among those with disorders who received treatment. Results Around 6% of respondents reported PMU in the past year: hypnotics or sedatives were used by 3.7% and antidepressants by 3.5%. Among individuals with 12-month disorders, only 14% reported past year PMU. Gender, age, education, income, occupational status, comorbidity, and severity were significant predictors for PMU. Among those with 12-month DSM-IV disorders who obtained treatment in healthcare settings, almost 40% received medication only. Among those treated in specialty mental health service, around 23% received combination of medication and psychotherapy. Conclusion Our study has pointed out that the recent trend of access to mental healthcare in Brazil depicts unmet needs, characterized by a low prevalence of PMU among individuals with psychiatric disorders. Policies that improve appropriate access to prescribed drugs for those most in need are urgent public health priority.
  • 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 6 Citação(ões) na Scopus
    A global field study of the international classification of diseases (ICD-11) mood disorders clinical descriptions and diagnostic guidelines
    (2021) KOGAN, Cary S.; MAJ, Mario; REBELLO, Tahilia J.; KEELEY, Jared W.; KULYGINA, Maya; MATSUMOTO, Chihiro; ROBLES, Rebeca; HUANG, Jingjing; ZHONG, Na; CHAKRABARTI, Subho; FIGUEIRA, Maria Luisa; STEIN, Dan J.; STRAKOWSKI, Stephen M.; GARCIA-PACHECO, Jose A.; BURNS, Samantha; MONTOYA, Madeline; ANDRADE, Laura; AYUSO-MATEOS, Jose L.; ARANGO, Ivan; BALHARA, Yatan Pal Singh; BRYANT, Richard; COURNOS, Francine; PORTO, Jose Alberto Del; MEYER, Thomas D.; MEDINA-MORA, Maria-Elena; GUREJE, Oye; FIRST, Michael B.; GAEBEL, Wolfgang; KHOURY, Brigitte; KRASNOV, Valery N.; MARI, Jair de Jesus; MARUTA, Toshimasa; PIKE, Kathleen M.; ROBERTS, Michael C.; SHARAN, Pratap; ZHAO, Min; REED, Geoffrey M.
    Background: We report results of an internet-based field study evaluating the diagnostic guidelines for ICD-11 mood disorders. Accuracy of clinicians' diagnostic judgments applying draft ICD-11 as compared to the ICD10 guidelines to standardized case vignettes was assessed as well as perceived clinical utility. Methods: 1357 clinician members of the World Health Organization's Global Clinical Practice Network completed the study in English, Spanish, Japanese or Russian. Participants were randomly assigned to apply ICD11 or ICD-10 guidelines to one of eleven pairs of case vignettes. Results: Clinicians using the ICD-11 and ICD-10 guidelines achieved similar levels of accuracy in diagnosing mood disorders depicted in vignettes. Those using the ICD-11 were more accurate in identifying depressive episode in recurrent depressive disorder. There were no statistically significant differences detected across classifications in the accuracy of identifying dysthymic or cyclothymic disorder. Circumscribed problems with the proposed ICD-11 guidelines were identified including difficulties differentiating bipolar type I from bipolar type II disorder and applying revised severity ratings to depressive episodes. Clinical utility of ICD-11 bipolar disorders was found to be significantly lower than for ICD-10 equivalent categories. Limitations: Standardized case vignettes were manipulated to evaluate specific changes. The degree of accuracy of clinicians' diagnostic judgments may not reflect clinical decision-making with patients. Conclusions: Alignment of the ICD-11 with current research appears to have been achieved without sacrificing diagnostic accuracy or clinical utility though specific training may be necessary as ICD-11 is implemented worldwide. Areas in which the ICD-11 guidelines did not perform as intended resulted in further revisions.
  • article 29 Citação(ões) na Scopus
    The psychosis continuum in the general population: findings from the Sao Paulo Epidemiologic Catchment Area Study
    (2011) LOCH, Alexandre Andrade; WANG, Yuan-Pang; ROESSLER, Wulf; TOFOLI, Luis Fernando; SILVEIRA, Camila Magalhaes; ANDRADE, Laura Helena
    The aim of the study was to examine the psychosis continuum in a Latin-American community setting. Data were from the Brazilian Sao Paulo Epidemiologic Catchment Area Study, a cross-sectional survey conducted in two boroughs of the city of Sao Paulo. The Composite International Diagnosis Interview (version 1.1) was applied to a probabilistic sample of 1,464 adults, who were interviewed in their household, in order to identify the presence of psychotic symptoms. A subsample was assessed with Schedules for Clinical Assessment in Neuropsychiatry interview. We described the occurrence of psychotic symptoms, categorized into subgroups according to their clinical impact, disability, and help-seeking behavior. The correlation of socio-demographic variables, depressive symptoms, and alcohol and substance use disorders with those psychotic subgroups was analyzed. Polychotomic logistic regression tested the associations between subgroups of psychosis (clinical and subclinical) and the correlates. Of the total sample, 38.0% presented at least one lifetime psychotic symptom, 1.9% met the criteria for an ICD-10 diagnosis of non-affective psychosis, 5.4% presented clinically relevant psychotic symptoms, and 30.7% endorsed clinically non-relevant symptoms. The most common psychotic symptom was delusion with a plausible explanation (in 18.6%). The presence of any psychiatric diagnosis was associated with the presence of psychotic symptoms (OR range, 1.9-8.9). Subclinical psychosis subgroups were found to be associated with the 18-24 year age bracket, chronic depressive mood, and alcohol use disorder. Our results support the concept of a psychosis continuum in Latin-American populations, suggesting that different risk factors influence their manifestation across the continuum.
  • 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 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.