O efeito da infeção pelo HIV no risco suicidário nos usuários de heroína

Dissertação de mestrado em Ciências da SaúdeSuicide is an important cause of death worldwide. HIV+ patients and heroin users are groups with elevated risk of suicide when separately compared to general population. Suicide has been also associated with psychiatric disorders as well as high cortisol levels. Still, suicide is hardly ever predicted and biological correlates to suicide are lacking. We aimed to investigate the effect of HIV infection on suicidal risk among heroin users in treatment with methadone, through a comparative study. Additionally, we assessed factors known to influence suicidal risk like stress (based on both cortisol levels and self-reported stress), anxiety and depression among HIV+ heroin users. A cross-sectional study was performed. Thirty-seven (37) HIV+ and fifty-two (52) HIV- heroin users participated in our study. Psychological evaluation was performed using the scales for depression (Hospital Depression Scale - HDS), anxiety (Hospital Anxiety Scale - HAS), perceived stress scale (PSS-10) and Beck Scale of Suicidal Ideation (BSS). Simultaneously, we measured salivary cortisol due to its correlation with stress. Our results revealed that the HIV+ heroin users had higher total suicidal ideation scores compared to HIV- heroin users. No statistically significant differences across groups were detected in neither perceived stress scores, nor in anxiety and depression frequencies. Among HIV+ patients, the higher the total self-reported scores reported by participants, the higher the total suicidal ideation scores obtained. Likewise, salivary cortisol levels correlated positively with total suicidal ideation scores. Individuals classified as presenting depression, as well as those classified as presenting anxiety showed higher total suicidal ideation scores when compared to those who were classified as presenting “no” depression or presenting “no” anxiety, respectively. These results suggest an additional effect of HIV infection on the risk of suicide among heroin users. Parallel to this, our findings highlighted the relevance of screening psychiatric disorders among heroin users in order to prevent suicide. Since a correlation between the cortisol level and suicidal ideation scores was detected, and cortisol level was shown to be a good predictor of suicidal ideation in a regression model of suicide made, it might be further explored as predictor of suicide risk.O suicídio é uma causa importante de morte a nível mundial. Pacientes VIH+ e usuários de heroína são grupos com elevado risco de suicídio quando isoladamente comparados com a população geral. O suicídio tem sido igualmente associado a perturbações psiquiátricas bem como a níveis elevados de cortisol. Entretanto, é difícil prever o suicídio e marcadores biológicos que se associem ao suicídio estão em falta. O presente estudo teve como objetivo investigar o efeito da infeção pelo VIH no risco de suicídio entre usuários de heroína em tratamento com metadona, através de um estudo comparativo. Adicionalmente avaliaram-se fatores conhecidos como tendo influência na ideação suicida como o stresse (baseados nos níveis de cortisol e no stresse percebido), ansiedade e depressão em usuários de heroína VIH+. Foi feito um estudo transversal. Trinta e sete (37) usuários de heroína VIH+ e cinquenta e dois (52) usuários de heroína VIH- participaram no nosso estudo. A avaliação psicológica foi feita através de escalas de depressão (Escala Hospitalar de Depressão), ansiedade (Escala Hospitalar de Ansiedade), Escala de Stresse Percebido (PSS-10) e Escala de Ideação Suicida de Beck (BSS). Em simultâneo, mediram-se os níveis de cortisol dos participantes devido à sua correlação com o estresse. Os resultados revelaram que os usuários de heroína VIH+ tiveram pontuações totais mais altas de ideação suicida do que os usuários de heroína VIH-. Não foram encontradas diferenças estatisticamente significativas entre os dois grupos nas pontuações de stresse percebido nem na frequência de ansiedade e depressão. Entre os pacientes usuários de heroína VIH+, quanto mais altas as pontuações de stresse percebido mais altos os valores totais de ideação suicida obtidos. Da mesma forma, os níveis de cortisol salivar tiveram uma correlação positiva com as pontuações totais de ideação suicida. Por outro lado, os participantes classificados como tendo depressão ou tendo ansiedade tiveram valores mais altos de ideação suicida do que os que foram classificados como não tendo depressão ou não tendo ansiedade, respetivamente. Estes resultados sugerem um efeito adicional da infeção pelo VIH no risco de suicídio entre pacientes usuários de heroína. Paralelamente, os nossos resultados salientam a importância do rastreio de patologias psiquiátricas entre usuários de heroína tendo em vista a prevenção do suicídio. Uma vez que o nível de cortisol correlacionouse com a pontuação de ideação suicida e que no modelo de regressão linear feito o nível de cortisol revelou-se um bom preditor de ideação suicida, poderá ser mais explorado como preditor de risco suicidário

Women's mental health in Mozambique: is maternity a protective factor?

Abstract Backgroud Globally, women have been shown to have high rates of common mental disorders (CMDs). In low and middle-income countries (LMICs), women face significant challenges related to maternity. However, no study has compared mental health problems among pregnant/post-partum women, childless women of childbearing age, and women with children in a low-income country. We sought to compare the frequency of CMD and suicide risk in a sample of women presenting or accompanying patients in primary care in two Mozambican semi-urban settings. Methods We administered the MINI International Neuropsychiatric Interview to 853 women, of whom 220 (25.8%) were pregnant/post-partum, 177 (20.8%) were non-pregnant and childless, and 456 (53.5%) were non-pregnant and with children more than 1-year-old. Logistic regression models compared the likelihood of a psychiatric disorder across groups, adjusting for sociodemographic and chronic-illness covariates. Results We found a high frequency of CMD and suicide risk among all women in this low-income context sample. In adjusted models, no differences in rates of depression, anxiety, or panic disorder were observed among groups. However, suicide risk was higher in women without children than pregnant/post-partum women. Conclusion The frequency of CMD among women of childbearing age in our study was higher than documented rates in high-income countries and other LMIC. Additionally, we found that motherhood was not protective and that pregnancy and the postpartum period were not stages of increased risk for most disorders. This highlights the need to expand mental health services not only for perinatal women but all women of childbearing age in this and possibly similar settings

Technology and implementation science to forge the future of evidence-based psychotherapies: the PRIDE scale-up study

Objective: To report the interim results from the training of providers in evidence-based psychotherapies (EBPs) and use of mobile applications. Design and setting: The Partnerships in Research to Implement and Disseminate Sustainable and Scalable Evidence (PRIDE) study is a cluster-randomised hybrid effectiveness-implementation trial comparing three delivery pathways for integrating comprehensive mental healthcare into primary care in Mozambique. Innovations include the use of EBPs and scaling-up of task-shifted mental health services using mobile applications. Main outcome measures: We examined EBP training attendance, certification, knowledge and intentions to deliver each component. We collected qualitative data through rapid ethnography and focus groups. We tracked the use of the mobile applications to investigate early reach of a valid screening tool (Electronic Mental Wellness Tool) and the roll out of the EBPs PARTICIPANTS: Psychiatric technicians and primary care providers trained in the EBPs. Results: PRIDE has trained 110 EBP providers, supervisors and trainers and will train 279 community health workers in upcoming months. The trainings improved knowledge about the EBPs and trainees indicated strong intentions to deliver the EBP core components. Trained providers began using the mobile applications and appear to identify cases and provide appropriate treatment. Conclusions: The future of EBPs requires implementation within existing systems of care with fidelity to their core evidence-based components. To sustainably address the vast mental health treatment gap globally, EBP implementation demands: expanding the mental health workforce by training existing human resources; sequential use of EBPs to comprehensively treat mental disorders and their comorbid presentations and leveraging digital screening and treatment applications. Keywords: adult psychiatry; anxiety disorders; depression & mood disorders; schizophrenia & psychotic disorders; substance misuse. © Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ

Family reintegration of homeless in Maputo and Matola: a descriptive study

Abstract Background Homelessness is a global and local social problem with underestimated prevalence. It has been shown to increase the risk of mental illness, raising concerns from mental health providers about the need for effective interventions targeting this population. Objectives The aim of this paper is to describe the mental health status of the homeless people in two urban setting in a low-income country, through using standardised clinical and socio-demographic assessments as well assessing potential predictors of family integration versus non-family integration among a group of homeless individuals receiving psychiatric and psychosocial treatment. Methods A descriptive study was performed in Maputo and Matola cities between 2008 and 2010. Homeless people with apparent mental illness were mapped and recruited. The participants were referred from community to hospital, using a multidisciplinary treatment model, according to their clinical condition and later entered a family reintegration process. Results Seventy-one homeless people were recruited (93.0% male; 80.3% unemployed). The most common diagnosis was schizophrenia and other psychosis (46; 64.8%), followed by mental and behaviour disorder related to substance misuse (21; 29.6%), and intellectual disability (4; 5.6%). Family reintegration was achieved for 53.5% (38 patients). Patients with intellectual disability were less reintegrated and those with disorders related to substance use had better reinsertion in their families (Chi square (2)  = 6.1; p = 0.047). Conclusions Family reintegration was achieved in more than half of participants after hospitalization. Integration was higher in cases of substance misuse, with those with associated intellectual disability being more difficult to reintegrate. Trial registration Trial Registration Number: NCT02936141, date of registration: 14/10/2016, retrospectively registered