Implicações da covid-19 na saúde mental, nos óbitos por suicídio e no acesso a serviços da rede psicossocial brasileira

O objetivo desta tese é compreender e avaliar as implicações da pandemia da COVID-19 em desfechos de saúde mental (SM) e no acesso a serviços da rede de atenção psicossocial brasileira. Para isso, foram realizados três estudos teóricos, desenvolvidos no período inicial da pandemia, e duas investigações originais com análise de dados secundários, concernentes ao primeiro ano da crise. No artigo 1, intitulado “‘Pandemic fear’ and COVID-19: mental health burden and strategies”, foi conduzida uma revisão teórica e, a partir de informações sobre surtos, epidemias e pandemias prévias, buscou-se compreender os potenciais impactos da COVID-19 na SM da população. Estimou-se que estaria ocorrendo uma pandemia de medo paralela à pandemia viral e, como consequência, o cenário da SM da população, que já era preocupante, provavelmente seria agravado. Diante disso, ofereceram-se recomendações iniciais para mitigar o impacto da crise na SM. Com método semelhante, no artigo 2, denominado “The impact of the COVID-19 pandemic on the mental health of healthcare professionals”, foram debatidos os reflexos da crise na SM dos profissionais da saúde, que se depararam com as sobrecargas física e emocional decorrentes do aumento do número de casos e de óbitos, e com a ausência de fármacos reconhecidamente eficazes para prevenir ou tratar a doença. Neste manuscrito, também foram sugeridas possíveis estratégias e intervenções para amenizar o impacto da pandemia na SM da população estudada. No artigo 3, “The COVID-19 pandemic and its impact on substance use: Implications for prevention and treatment”, foram discutidas as consequências da pandemia na SM de pacientes com transtornos por uso de substâncias. Este grupo é caracterizado pelo alto índice de problemas clínicos e psicossociais e, portanto, particularmente sensível ao estresse pandêmico. Entretanto, o acesso a medidas terapêuticas pode ter sido dificultado em decorrência das medidas de contenção da transmissão do vírus. No artigo 4, “The next pandemic: impact of COVID-19 in mental healthcare assistance in a nationwide epidemiological study”, foram analisados os dados oficiais sobre o acesso a serviços de SM ocorridos no Sistema Único de Saúde brasileiro. Observou-se uma redução drástica nos atendimentos de SM ambulatoriais e hospitalares, um aumento das consultas de emergência e de atendimentos domiciliares e a estabilização dos atendimentos por risco de suicídio durante os seis primeiros meses da crise, em comparação ao que seria esperado. No artigo 5, “Differential impact in suicide mortality during the COVID-19 pandemic in Brazil”, foram avaliados os óbitos por suicídio ocorridos no Brasil, comparando os períodos pré e intracrise. Verificou-se que, apesar da estabilidade geral do número de mortes autoprovocadas, houve um aumento em mulheres e idosos. Análises estratificadas demonstraram que o aumento dos suicídios ocorreu de forma heterogênea entre grupos populacionais de diferentes regiões do Brasil. Houve aumento de suicídios em populações com histórico de dificuldade de acesso à saúde, que podem ter sido severamente impactadas pela pandemia. Em conjunto, esses dados indicam que os impactos da crise pandêmica extrapolam a esfera física e podem agravar o cenário da SM. As consequências da pandemia são múltiplas e podem variar ao longo do tempo. Assim, é fundamental que investigações futuras sigam monitorando desfechos de SM nos próximos anos.The objective of this thesis is to understand and evaluate the implications of the COVID-19 pandemic on mental health (MH) outcomes and access to services in the Brazilian psychosocial care network. For this, three theoretical studies were carried out, developed in the initial period of the pandemic, and two original investigations with analysis of secondary data, concerning the first year of the crisis. In article 1, entitled “'Pandemic fear' and COVID-19: mental health burden and strategies”, a theoretical review was carried out and, based on information on previous outbreaks, epidemics, and pandemics, an attempt was made to understand the potential impacts of COVID-19. -19 in the MS of the population. It was estimated that a fear pandemic would be occurring parallel to the viral pandemic and, therefore, the population's MS scenario, which was already worrying, would probably be worsened. In view of this, initial recommendations were offered to mitigate the impact of the crisis on MS. With a similar method, in article 2, called “The impact of the COVID-19 pandemic on the mental health of healthcare professionals”, the reflexes of the crisis on the MH of health professionals, who faced the resulting physical and emotional overloads, were discussed. the increase in the number of cases and deaths, and the absence of drugs known to be effective to prevent or treat the disease. In this manuscript, possible strategies and interventions were also suggested to mitigate the impact of the pandemic on MS in the population studied. In article 3, “The COVID-19 pandemic and its impact on substance use: Implications for prevention and treatment”, the consequences of the pandemic on MS in patients with substance use disorders were discussed. This group is characterized by a high rate of clinical and psychosocial problems and is therefore particularly sensitive to pandemic stress. However, access to therapeutic measures may have been hampered because of measures to contain the transmission of the virus. In article 4, “The next pandemic: impact of COVID-19 in mental healthcare assistance in a nationwide epidemiological study”, official data on access to MH services in the Brazilian Unified Health System were analyzed. There was a drastic reduction in outpatient and hospital MH visits, an increase in emergency consultations and home visits, and a stabilization of visits for suicide risk during the first six months of the crisis, compared to what would be expected. In article 5, “Differential impact in suicide mortality during the COVID-19 pandemic in Brazil”, the deaths by suicide that occurred in Brazil were evaluated, comparing the pre-and intra-crisis periods. It was found that, despite the general stability in the number of self-inflicted deaths, there was an increase in women and the elderly. Stratified analyzes showed that the increase in suicides occurred heterogeneously among population groups from different regions of Brazil. There has been an increase in suicides in populations with a history of difficult access to healthcare, which may have been severely impacted by the pandemic. Taken together, these data indicate that the impacts of the pandemic crisis go beyond the physical sphere and can worsen the MH scenario. The consequences of the pandemic are multiple and can vary over time. Thus, it is essential that future investigations continue to monitor MS outcomes in the coming years

The sum of fears in cancer patients inside the context of the COVID-19

The pandemic resulting from COVID-19 has led to the collapse of the health system in dozens of countries. Parallel to clinical risk, the appearance or intensification of psychiatric symptoms has also been documented. The identification of groups at risk is essential for the establishment of preventive and therapeutic strategies. Cancer patients appear to be especially vulnerable both from a clinical and psychiatric perspective. Problems related to contamination and the cancer treatments themselves are intertwined, causing a sum of patients' fears to arise, which can cause mental effects. This study aims to review and investigate the impact of COVID-19 on the mental health of cancer patients and indicate possible support strategies

Multiple clinical risks for cannabis users during the COVID-19 pandemic

The pandemic caused by Sars-CoV-2 (COVID-19) has been a great concern for public and mental health systems worldwide. The identification of risk groups is essential for the establishment of preventive and therapeutic strategies, as for substance users. During COVID-19 pandemic, there was an increase in the use of psychoactive substances during the lockdown, including cannabis. This commentary reviews relevant findings and discusses scientific evidence on the risks of worse clinical and psychiatric complications due to coronavirus disease COVID-19 in subjects who use cannabis. Although they are not included as a risk group in the health recommendations for that disease, they may have a more vulnerable respiratory system to viral diseases. There are certain similarities between the harmful cardiovascular and respiratory effects of cannabis use and those of smoking. Due to the different modes of smoking, cannabis chemicals are retained in the body for longe and may also contain other toxic substances such as tar, a substance found in tobacco and which has been associated with the development of lung cancer, bronchitis and pulmonary emphysema. Therefore, we discuss if individuals who use cannabis regularly might be more vulnerable to COVID-19 infection. This population deserves more clinical attention worldwide and this manuscript can help clinicians become more aware of cannabis risks during pandemics and develop specific intervention strategies

Childhood trauma subtypes may influence the pattern of substance use and preferential substance in men with alcohol and/or crack-cocaine addiction

Objective: To compare the prevalence and subtypes of childhood maltreatment (CM) between individuals with and without substance use disorder (SUD) and investigate the influence of different traumas on the preferential use of substances and the severity of dependence. Methods: The sample consisted of 1,040 men with SUD (alcohol users [n=315], crack-cocaine users [n=406], multiple-substance users [n=319]) and 201 controls. The Childhood Trauma Questionnaire (CTQ) and the Addiction Severity Index-6 (ASI-6) were used to assess CM and drug-use patterns. Results: Individuals with SUD had a higher prevalence of CM than controls (63.4 vs. 28.1%, respectively). Exposure to physical trauma was associated with alcohol use disorder and severity of alcohol use. In contrast, emotional trauma was associated with use of multiple substances and severity of drug use in crack-cocaine users. Conclusions: This study corroborates the association of CM with SUD susceptibility. Our results suggest that the type of CM may influence preferential substance use and addiction severity. In this sense, physical traumas are more associated with alcohol use, while emotional and sexual traumas favor use of multiple drugs, especially crack cocaine. These findings may help the development of tailored prevention and intervention strategies

Problematic consumption of online pornography during the COVID-19 pandemic : clinical recommendations

The coronavirus disease (COVID-19) pandemic is one of the greatest contemporary challenges. Feelings of fear and uncertainty triggered by this pandemic have had noxious effects on people’s mental health. This seems to have increased during quarantine and there is evidence of an intensification of reward-directed behavior. Nevertheless, there are few studies dealing with pornography consumption during this period. The aim of this manuscript is to contextualize this phenomenon during the pandemic and suggest some clinical recommendations on the matter

Obsessive-compulsive disorder reinforcement during the COVID-19 pandemic

The COVID-19 pandemic is unquestionably impacting on the mental health of the population worldwide. Fear of contamination can both increase levels of stress in healthy individuals and intensify psychiatric symptoms in patients with pre-existing conditions, especially obsessive-compulsive disorder (OCD). During the COVID-19 pandemic, the imminent risk of contamination creates a logical need for self-surveillance and hygiene habits. However, this kind of information can have drastic implications for subjects with OCD, since cognitive distortions and compensatory strategies (cleansing rituals) are no longer irrational or oversized – rather, these ideas become legitimate and socially accepted, generating plausible validation for the intensification of compulsive cleaning rituals. Patients who presented remission of OCD symptoms would be more likely to have a relapse, and subclinical patients may scale up and ultimately be diagnosed with OCD due to the reinforcement of their habits, emotions and thoughts