Mental health and psychiatric care in Bolivia: what do we know?

Background: Recently Bolivia has implemented a universal health system, but their mental health policy is still emerging.Objectives: To investigate the current state of the mental health care system in Bolivia and discuss challenges for structuring a coordinated network of services that can effectively meet the needs of the Bolivian population.Methods: This review was conducted by searching for scholarly articles through the databases Lilacs, Medline OPS, HISA and IBECS REPIDISCA via the search portal in the Virtual Health Library - NLM (www.bireme.br).Results: Bolivia has a National Mental Health Plan that is intended to guide mental health promotion, prevention, treatment and rehabilitation of mental illness, but the resources for this area of health are limited. There are 1.06 psychiatrists and 0.46 psychologists per 100, 000 inhabitants. Information on psychiatric morbidity in Bolivia and the impact of mental disorders on the global burden of disease is scarce. Admission statistics reported by psychiatric hospitals in the country show that the main cause of hospitalization is substance abuse (30%). Alcohol consumption is responsible for 90% of these admissions, in addition to being a major cause of deaths in traffic and one of the main risk factors for domestic violence. Almost one in two women in Bolivia (47%) experienced some form of violence from their partner in the last year. Nineteen percent of women living with a partner reported being physically abused, while 7% were sexually abused by their partners. Isolated studies report that suicide rates are disproportionately high in Bolivia.Conclusions: Although there is a shortage of epidemiological data in Bolivia, it is clear the impact of alcohol addiction in psychiatric admissions, domestic violence and traffic accidents. Violence against women and suicides are important issues to be tackled. Among the proposed strategies to afford human resources for mental health in Bolivia, task shifting, the delegation of tasks to non-specialists should be extensively adopted in the country to improve mental health care.Universidade Federal de São Paulo, Dept Psiquitria, BR-04038000 São Paulo, BrazilSt Louis Univ, Sch Med, St Louis, MO USAUniversidade Federal de São Paulo, Dept Psiquitria, BR-04038000 São Paulo, BrazilWeb of Scienc

A cross-sectional study to compare levels of psychiatric morbidity between young people and adults exposed to violence in a large urban center

Background Teenagers and young adults are more exposed to violence and traumatic events than adults, and these factors can be associated with mental disorders. This paper aims at investigating whether young people are more exposed to violence and traumatic events and to compare pattern of mental disorders with adults. Methods Cross-sectional study using the Composite International Diagnostic Interview, conducted between 2007 and 2008 with a randomly selected sample of 15 to 75 year-old residents of São Paulo, Brazil. Results Two thousand five hundred thirty-six participants were divided into two groups: 1096 (43.2 %) young people (15 to 24 years), and 1440 (56.8 %) adults (25 to 75 years). 12-month exposure to traumatic events was higher among young people (32.1 % vs. 20.6 %; p < 0.001). Assaultive violence was reported by 13.4 % of young people and 8.6 % of adults (p = 0.012); 20.1 % of young people and 13 % of adults reported suffering other injury or shocking events (p < 0.001); sudden death/life threatening illness of a close person was declared by 6.1 % of young people and 3.2 % of adults (p = 0.017). Prevalence of alcohol related disorders was higher among young people (5.4 % vs. 2.5 %; P = 0.032); depressive disorders were more prevalent among adults (9.0 % vs. 4.7 %; P = 0.004). Alcohol related disorders were associated to assaultive violence among young people (OR = 3.4; 95 % CI = 1.36 to 8.52; p = 0.004) and adults (OR = 2.38; 95 % CI = 1.23 to 4.61; p = 0.002). Phobic/anxiety disorders were associated to other injury or shocking events among young people (OR = 1.28; 95 % CI = 0.67 to 2.44; p = 0.025). Major depressive disorder was associated to assaultive violence among young people (OR = 2.27; 95 % CI = 1.09 to 4.74; p = 0.004) and adults (OR = 1.28; 95 % CI = 0.85 to 1.93; p = 0.009). Conclusion Exposure to violence and traumatic events was higher among young people. Alcohol related disorders, depression and phobic/anxiety disorders were significantly higher among young people exposed to traumatic events. Despite the study design, high exposure to violence and traumatic events in this age group can be considered important factors in triggering mental disorders in this vulnerable age period

Adaptation to Brazilian Portuguese and Latin-American Spanish and psychometric properties of the Mental Illness Clinicians’ Attitudes Scale (MICA v4)

Objective: To describe translation to Spanish and Portuguese and adaptation of the Mental Illness Clinicians’ Attitudes Scale version 4 (MICA v4). Methods: The questionnaire was administered to primary care physicians (PCPs) from four Latin- American countries, Brazil, Bolivia, Chile, and Cuba. The validation process included four phases: 1) translation of the questionnaire to Spanish and Portuguese; 2) assessment of face validity; 3) assessment of reliability; and 4) evaluation of construct validity with confirmatory factor analysis (CFA). Results: The study sample comprised 427 PCPs. The mean age of the Spanish-speaking sample (n =252) was 40.1 (S.D = 9.7) years and the mean age of the Portuguese-speaking sample (n = 150) was 40.2 (S.D = 10.9) years. Both models demonstrated “appropriate” internal reliability. Total omega was 0.91 for the Spanish-speaking sample and 0.89 for the Portuguese-speaking sample. The CFA of both questionnaires showed an appropriate fit for a three-factor model (Portuguese: CFI = 0.927; TLI = 0.913; RMSEA = 0.066; Spanish: CFI = 0.945; TLI = 0.935; RMSEA = 0.068). Conclusion: The Latin-American versions of the MICA v4 in Spanish and Brazilian Portuguese have appropriate psychometric properties, good internal consistency, and are applicable to and acceptable in the Latin-American context. The instrument proved its validity for collecting data on stigmatizing attitudes among health professionals in different contexts and cultures

O impacto da exposição à violência e outros eventos traumáticos nos transtornos mentais dos adolescentes e adultos jovens na cidade de São Paulo

Teenagers and young adults are more vulnerable and more exposed to violence and traumatic events than adults, and these factors can be associated with mental disorders. Objectives: The aim of this study is to evaluate if young people are indeed more exposed to violence and traumatic events and to compare pattern of mental disorders with the adult population. Methods: A cross-sectional study using the Composite International Diagnostic Interview was conducted between 2007 and 2008 with a randomly selected sample of São Paulo, Brazil: residents ranging from 15 to 75 years of age, were divided into young-adult and adult groups. Results: A sample of 2,536 individuals were interviewed and divided in the following two groups: 1,096 (43.2%) young people aged from 15 to 24, and 1,440 (56.8%) adults aged from 25 to 75. Exposure to traumatic events in the 12 months before to the interview was significantly higher among young people (32.1% vs. 20.6%; p<0.001). Exposure to assaultive violence reached 13.4% of young people and 8.6% of adults (p=0.012); 20.1% of young people reported suffering other injury or shocking events, as opposed to 13% of adults (p<0.001); sudden death/life threatening illness of a close person was declared by 6.1% of young people and 3.2% of adults (p=0.017). Prevalence of alcohol abuse was significantly higher among young people (5.4% vs. 2.5%; P=0.032), whereas depressive disorders were significantly more common among adults (9.0% vs. 4.7%; P=0.004). Alcohol related disorder was associated to assaultive violence among young people (OR=3.69; p=0.004) and adults (OR=2.93; p=0.002). Phobic anxiety disorders were associated to other injury or shocking events among young people (OR=3.51; p=0.025). Major depressive disorder was associated to assaultive violence among young people (OR=3.13; p=0.004) and adults (OR=1.66; p=0.009). Conclusion: Exposure to every form of violence and traumatic events was significantly more prevalent among young people. Alcohol abuse, depression and phobic anxiety disorders were significantly higher among young people exposed to traumatic events. Although this is a crosssectional study the high exposure to violence and traumatic events in this age group can be important factors of triggering mental disorders in this vulnerable age period.Adolescentes e adultos jovens são mais vulneráveis e mais expostos à violência e eventos traumáticos do que os adultos, e esses fatores podem ser associados a transtornos mentais. Objectivo: O objectivo deste estudo é avaliar se os jovens são de fato mais expostos à violência e eventos traumáticos e comparar padrão de transtornos mentais com a população adulta. Métodos: Um estudo transversal com o Composite International Diagnostic Interview foi realizado entre 2007 e 2008 com uma amostra aleatória da população da cidade de São Paulo, Brasil: os participantes com idade 15 a 75 anos foram divididos em grupos de jovens adultos e adultos. Resultados: 2.536 indivíduos foram entrevistados e divididos em dois grupos: 1.096 (43,2%) jovens com idade entre 15-24, e 1.440 (56,8%) adultos com idade de 25 a 75. A exposição a eventos traumáticos nos 12 meses anteriores a entrevista foi significativamente maior entre os jovens (32,1% vs. 20,6%; p <0,001). A exposição à violência direta e intencional atingiu 13,4% dos jovens e 8,6% dos adultos (p = 0,012); 20,1% dos jovens e 13% dos adultos (p<0,001) relataram sofrer exposição a outros ferimentos ou eventos impactantes; notícia de doença grave ou morte repentina uma pessoa próxima foi declarada por 6,1% dos jovens e 3,2% dos adultos (p = 0,017). A prevalência de abuso de álcool foi significativamente maior entre os jovens (5,4% vs. 2,5%; P = 0,032), enquanto os transtornos depressivos foram significativamente mais comuns entre os adultos (9,0% vs. 4,7%; P = 0,004). Transtornos fóbico-ansiosos estiveram associados a outras lesões ou acontecimentos impactantes entre os jovens (OR = 3,51; p = 0,025). O transtorno depressivo maior foi associado à violência direta e intencional entre os jovens (OR = 3,13; p = 0,004) e adultos (OR = 1,66; p = 0,009). Conclusão: A exposição a todas as formas de violência e eventos traumáticos foi significativamente maior entre os jovens. O abuso de álcool, depressão e transtornos fóbico-ansiosos foram significativamente maior entre os jovens expostos a eventos traumáticos. Embora este seja um estudo transversal, a alta exposição à violência e eventos traumáticos nessa faixa etária pode ser um fator importante para desencadear transtornos mentais neste período vulnerável da vida.Dados abertos - Sucupira - Teses e dissertações (2013 a 2016

Suicídio entre adolescentes de 10 a 19 anos, métodos utilizados e sua relação entre os indicadores socioeconômicos no Brasil: um estudo ecológico e retrospectivo de 10 anos

Introduction:In Brazil, suicide ranks among the leading causes of death in young people, ranking fourth for 15- to 29-year-olds, there are striking gender differences in suicide rates. Suicide is the third leading cause of death among males (9.0 per 100,000 people each year) and the eighth leading cause among females (2.4 per 100,000 people each year). Main objective:Suicide rates among Brazilian adolescents have increased in recent years. Obtaining a better understanding of the methods adolescents use for suicide, and whether these methods have changed in recent years, may inform future preventive measures. Specific objectives: Study 1: To examine suicide rates among adolescents from six large cities in Brazil and to analyze the relationship between adolescent suicide rates and socioeconomic indicators between 2006 and 2015. Study 2: The aim of this study was to describe the most commonly used methods of suicide among adolescents aged 10 to 19 years in Brazil between 1 January 2006 and 31 December 2015. Methods: This study employed a retrospective ecological design, for the period of 1 January 2006 to 31 December 2015. To be included in this study, data relating to the suicide methods used by adolescents in Brazil were collected according the chronological limits of adolescence. of 10- 19 years and by sex (male and female). Suicide methods were obtained from the Information Technology Department of the Public Health Care System (DATASUS) of the Brazilian Ministry of Health Study 1: Generalized estimating equation models were used to assess the impact of socioeconomic factors – including social inequality and unemployment rates – on adolescent suicide rates. Study 2: In Brazil, suicide methods are registered using the International Classification of Disease 10th version (ICD-10) codes X60–X84, which indicate the main methods of suicide, and Y10–Y19, which indicate poisoning and exposure to substances with undetermined intent. Suicide methods were obtained from the DATASUS of the Brazilian Ministry of Health. xiv Results: Study 1: The rate of adolescent suicide increased by 24% over the course of the study period. Social inequality (assessed using the Gini index), was positively associated with overall adolescent suicide rates (β = 10.68; 95% CI = 2.32-19.05; p ≤ 0.012). After disaggregating the findings by age (10-14 and 15-19 years), social inequality was associated with suicide rate only for adolescents aged 15-19 years (β = 9.63; 95% CI = 2.31-16.96; p ≤ 0.005). Disaggregating these findings by sex, the association with economic variables became significant only among females. Males had a higher overall suicide rate than females, and the highest rate was observed in male adolescents aged 15-19 years. Higher levels of unemployment were associated with higher suicide rates. Study 2: 8026 suicides among Brazilian adolescents aged between 10–19 years were registered over the analyzed period. The most commonly used method of suicide by both sexes was hanging (2006= 54.9%; 2015= 70.3%). A relative increase was observed in males (2006= 62.9%; 2015= 72.3%), whereas a steeper increase was observed in females (2006= 39.27%; 2015= 65.82%). The proportional use of firearms (2006= 14.2%; 2015= 9.1%) and poisoning (2006= 13.3%; 2015= 9.2%) decreased over the period (-5.1% and -1.6% respectively). Conclusion: Study 1: Our findings suggest that socioeconomic indicators, particularly unemployment and social inequality, are relevant social determinants of suicide in adolescence. Study 2: The increase in hanging is worrisome, mostly regarding difficulties to impose access barriers and its high lethality. In such context, a comprehensive understanding of suicide behaviors among adolescents in Brazil should be drawn to inform general prevention measures and, more specifically, the reasons for the increase in hanging needs to be further investigated.Introdução: No Brasil, o suicídio é a quarta principal causa de morte entre jovens de 15 a 29 anos. Recentemente, houve um aumento do suicídio neste grupo e, mudar esse viés de alta, tem sido um importante desafio para as políticas preventivas. Objetivo principal: Investigar fatores associados às mudanças nas taxas de suicídio em jovens nos últimos 10 anos no Brasil. Objetivos específicos: Estudo 1: Analisar as taxas de suicídio entre adolescentes de seis grandes cidades do Brasil e avaliar a relação entre as taxas de suicídio entre adolescentes e indicadores socioeconômicos no período de 2006 a 2015. Estudo 2: Descrever os métodos de suicídio mais utilizados pelos adolescentes de 10 a 19 anos no Brasil, no período de 2006 a 2015. Métodos: Primeiramente, foi utilizado um delineamento ecológico retrospectivo, no período de 1 de janeiro de 2006 a 31 de dezembro de 2015. Para serem incluídos neste estudo, os dados referentes aos métodos de suicídio utilizados pelos adolescentes no Brasil foram coletados segundo os limites cronológicos da adolescência (de 10 a 19 anos) e por sexo (masculino e feminino). Os métodos de suicídio foram obtidos do Departamento de Informática do Sistema Único de Saúde (DATASUS) do Ministério da Saúde do Brasil. No estudo 1, foram utilizados modelos de equações de estimativas generalizadas com o objetivo de avaliar o impacto de fatores socioeconômicos – incluindo desigualdade social e taxas de desemprego – nas taxas de suicídio de adolescentes. Já no estudo 2, os métodos de suicídio foram registrados usando os códigos X60-X84 da Classificação Internacional de Doenças 10ª Edição (CID-10), que indicam os principais métodos de suicídio, e Y10-Y19, que indicam intenção, intoxicação e exposição a substâncias indeterminadas. Os métodos de suicídio foram obtidos através do DATASUS do Ministério da Saúde. Resultados: Estudo 1: A taxa de suicídio de adolescentes aumentou em 24% no período de 2006 a 2015. A desigualdade social, avaliada pelo índice de Gini, foi positivamente associada com as taxas totais de suicídio entre adolescentes (β = 10,68; IC95% = 2,32-19,05; p ≤ 0,012). Ao separar os grupos por idade (10 a 14 e 15 a 19 anos), a xii desigualdade social esteve associada à taxa de suicídio apenas nos adolescentes de 15 a 19 anos (β = 9,63; IC95% = 2,31-16,96; p ≤ 0,005). Entretanto, ao separar esses achados por sexo, a associação com as variáveis econômicas tornou-se significativa apenas entre as mulheres. Os homens demostraram uma taxa de suicídio geral maior do que as mulheres e a taxa mais alta foi observada entre 15 a 19 anos. Níveis mais altos de desemprego foram associados à taxas mais altas de suicídio. Estudo 2: Foram registrados 8026 suicídios entre adolescentes brasileiros, com idade entre 10 a 19 anos, no período de 2006 a 2015. O método de suicídio mais comumente utilizado por ambos os sexos foi enforcamento (2006= 54,9%; 2015= 70,3%). Um aumento relativo foi observado no sexo masculino (2006= 62,9%; 2015= 72,3%), enquanto um aumento mais acentuado foi observado no sexo feminino (2006= 39,27%; 2015= 65,82%). O uso proporcional de armas de fogo (2006= 14,2%; 2015= 9,1%) e envenenamento (2006 = 13,3%; 2015 = 9,2%) diminuiu no período (- 5,1% e -1,6% respectivamente). Conclusão: Estudo 1: Nossos resultados sugerem que os indicadores socioeconômicos, particularmente o desemprego e a desigualdade social, são determinantes sociais relevantes do suicídio na adolescência. Estudo 2: O aumento do enforcamento é preocupante, principalmente em relação às dificuldades de impor barreiras de acesso e sua alta letalidade. Nesse contexto, uma compreensão abrangente dos comportamentos suicidas entre os adolescentes no Brasil deve ser desenhada para informar as medidas gerais de prevenção.Dados abertos - Sucupira - Teses e dissertações (2019

The association between adolescent suicide rates and socioeconomic indicators in Brazil: a 10-year retrospective ecological study

Objective: To examine suicide rates among adolescents from six large cities in Brazil and to analyze the relationship between adolescent suicide rates and socioeconomic indicators between 2006 and 2015. Methods: Generalized estimating equation models were used to assess the impact of socioeconomic factors – including social inequality and unemployment rates – on adolescent suicide rates. Results: The rate of adolescent suicide increased by 24% over the course of the study period. Social inequality (assessed using the Gini index), was positively associated with overall adolescent suicide rates (β = 10.68; 95%CI = 2.32-19.05; p ≤ 0.012). After disaggregating the findings by age (10-14 and 15-19 years), social inequality was associated with suicide rate only for adolescents aged 15-19 years (β = 9.63; 95%CI = 2.31-16.96; p ≤ 0.005). Disaggregating these findings by sex, the association with economic variables became significant only among females. Males had a higher overall suicide rate than females, and the highest rate was observed in male adolescents aged 15-19 years. Higher levels of unemployment were associated with higher suicide rates. Conclusion: Our findings suggest that socioeconomic indicators, particularly unemployment and social inequality, are relevant social determinants of suicide in adolescence