Comorbidity in post-traumatic stress disorder: A population-based study from the two largest cities in Brazil

Background: This study investigated the patterns of comorbidity between PTSD and depression, other anxiety disorders, alcohol-related disorders using the DSM-IV and ICD-10 criteria. The temporal sequence of the comorbid diagnoses was also investigated. Methods: We used data from a large population-based survey carried out between 2007 and 2008 in the two largest cities in Brazil: São Paulo and Rio de Janeiro. Results: Diagnoses of depression, other anxiety disorders, and alcohol-related disorder were more prevalent in the people with PTSD than in those without PTSD. Using the DSM-IV criteria, approximately 67% of cases presenting PTSD were also diagnosed with another mental disorder. The diagnosis category of other anxiety disorders presented the highest proportion of comorbidity (53%). Depression was found in 34% person with PTSD whilst alcohol-related disorders were observed in 7%. Considering the temporal relationship, the onset of comorbid depression was uniformly distributed through the periods before, within the same year and after PTSD's onset. When other anxiety disorders were comorbid with PTSD, in almost 90% of the cases the other anxiety disorders preceded PTSD. For comorbidity between of alcohol-related disorders and PTSD, in 50% of the cases alcohol-related disorders preceded the diagnosis of PTSD. Limitations: The cross-sectional design imposes limitations on establishing a temporal relationship between the onset of psychiatric disorders due to memory bias. Conclusions: Our findings indicate that among individuals presenting comorbid PTSD and other anxiety disorders, this diagnosis tend to precede PTSD. Comorbid cases are more frequent and more severe, and this should be taken into account in therapeutic research and clinical practice

Violence and post-traumatic stress disorder in Sao Paulo and Rio de Janeiro, Brazil: the protocol for an epidemiological and genetic survey

Background: violence is a public health major concern, and it is associated with post-traumatic stress disorder and other psychiatric outcomes. Brazil is one of the most violent countries in the world, and has an extreme social inequality. Research on the association between violence and mental health may support public health policy and thus reduce the burden of disease attributable to violence. the main objectives of this project were: to study the association between violence and mental disorders in the Brazilian population; to estimate the prevalence rates of exposure to violence, post-traumatic stress disorder, common metal disorder, and alcohol hazardous use and dependence: and to identify contextual and individual factors, including genetic factors, associated with the outcomes.Methods/design: one phase cross-sectional survey carried out in São Paulo and Rio de Janeiro, Brazil. A multistage probability to size sampling scheme was performed in order to select the participants (3000 and 1500 respectively). the cities were stratified according to homicide rates, and in São Paulo the three most violent strata were oversampled. the measurements included exposure to traumatic events, psychiatric diagnoses (CIDI 2.1), contextual (homicide rates and social indicators), and individual factors, such as demographics, social capital, resilience, help seeking behaviours. the interviews were carried between June/2007 February/2008, by a team of lay interviewers. the statistical analyses will be weight-adjusted in order to take account of the design effects. Standardization will be used in order to compare the results between the two centres. Whole genome association analysis will be performed on the 1 million SNP (single nucleotide polymorphism) arrays, and additional association analysis will be performed on additional phenotypes. the Ethical Committee of the Federal University of São Paulo approved the study, and participants who matched diagnostic criteria have been offered a referral to outpatient clinics at the Federal University of São Paulo and Federal University of Rio de Janeiro

Resilience to traumatic events: concept, execution and cross-sectional study

Made available in DSpace on 2011-05-04T12:42:02Z (GMT). No. of bitstreams: 0 Previous issue date: 2009Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Rio de Janeiro, RJ, Brasil.Introdução: A resiliência pode ser conceituada como um processo dinâmico que leva à adaptação positiva diante de uma adversidade e que envolve a interação entre processos sociais e intrapsíquicos de risco e de proteção. Metodologia: Tese composta por trêsartigos independentes, que apresentam a resiliência como aspecto comum. O primeiro deles apresenta uma revisão sistemática sobre a operacionalização do conceito de resiliência em estudos epidemiológicos sobre o transtorno de estresse pós-traumático (TEPT) seguido a eventos de violência urbana e/ou íntima. O segundo artigo traz uma revisão sistemática sobre as propriedades psicométricas da Escala de Resiliência e de suas diferentes versões. As bases de dados nas duas revisões foram: ISI; MEDLINE; PILOTS e LILACS. O terceiro artigo investigou os fatores associados à resiliência a eventos traumáticos a partir dos dados de um inquérito epidemiológico domiciliar conduzido com uma amostra representativa da população com 15 anos ou mais residente na cidade de São Paulo. A associação foi investigada através de modelos logísticos multivariados hierárquicos, tanto para traumas intensos quanto para aquelesleves/moderados. Resultados: Artigo 1) Estudos epidemiológicos sobre violência íntima e/ou urbana são relativamente recentes e muito heterogêneos no modo como operacionalizam o conceito de resiliência junto ao TEPT. Artigo 2) A literatura apresenta críticas sobre a capacidade de um instrumento único abranger a complexidade do fenômeno de resiliência. No entanto, a Escala de Resiliência vem sendo amplamente aplicada, apresentando boas propriedades psicométricas em suas diferentes versões, e sugerindo ser um instrumento útil para aferir alguns fatores individuais de resiliência. Artigo 3) O estudo seccional conduzido em São Paulo exemplificou a proposta de um método de análise que combina algumas formas de operacionalização da resiliência, demonstrando congruência dos achados (isto é, com maiores escores da Escala de Resiliência predizendo ausência de patologia após um evento traumático e com o grupo classificado como resiliente - através dessa operacionalização de adaptação positiva - apresentando os maiores escores de bem-estar). Conclusão: Apesar da complexidade do fenômeno de resiliência, a congruência dos achados aponta para a possibilidade de uma cada vez melhor apreensão do construto, favorecendo o entendimento sobre o que pode contribuir para a superação de eventos traumáticos pelos indivíduos a eles expostos.Introduction: The resilience can be conceptualized as a dynamic process that leads to positive adaptation in the face of adversity and involves the interaction between intrapsychic and social processes of risk and protection. Methods: Thesis of three independent articles, which have the resilience as common theme. The first one presents a systematic review on the operationalization of the resilience concept in epidemiological studies on Postttraumatic Stress Disorder (PTSD) following events of urban and/or intimate violence. The second article provides a systematic review on the psychometric properties of the Resilience Scale, and their different versions. The databases in the two revisions were: ISI, MEDLINE, LILACS and PILOTS. The third article investigates the factors associated with resilience to traumatic events from the data of a household survey conducted with a representative sample of the population aged 15 years or more living in the city of São Paulo. The association was investigated using hierarchical multivariate logistic models for both trauma intense as those for light / moderate. Results: Article 1) Epidemiological studies on PTSD followed intimate and/or urban violence are relatively recent and very heterogeneous in how operationalize the resilience concept. 2) The literature presents criticism on the ability of a single instrument to cover the complexity of the resilience phenomenon. However, the Resilience Scale has been widely applied, showing good psychometric properties in different versions, and suggesting to be a useful tool to assess individual factors of resilience. 3) The cross-sectional study conducted in São Paulo illustrated the proposal for a method of analysis that combines some forms of operationalization of resilience, demonstrating consistency of findings (with higher scores of the Resilience Scale predicting absence of disease after a traumatic event and the group classified as resilient - through the operationalization of "positive adjustment" - showing the higher scores of well-being). Conclusion: Despite the complexity of the phenomenon of resilience, the congruence of findings points to the possibility of an even better understanding of the construct, facilitating the comprehension of what can help to overcome traumatic events on individuals exposed to them

Translations, adaptation to portuguese and study of the quality of a scale to identification of the phobic disorders in population adolescent

Made available in DSpace on 2012-09-06T01:10:57Z (GMT). No. of bitstreams: 2 license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) 470.pdf: 1844041 bytes, checksum: 277bdc0c58f1f1b44d88fd633c79c08b (MD5) Previous issue date: 2002Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Rio de Janeiro, RJ, Brasil.Fobia social é definida como ansiedade extrema às situações sociais, que leva, em muitos casos, à sua esquiva, interferindo no funcionamento social, acadêmico e ocupacional do indivíduo. Vem sendo associada a pior qualidade de vida, abuso de substâncias, depressão e outros transtornos mentais. Freqüentemente, tem início na adolescência e curso crônico. Até o momento, não há nenhum instrumento de autopreenchimento para a identificação desse transtorno mental que tenha sido validado para a população brasileira. Objetivo: Traduzir, adaptar para o português e estudar a qualidade do social phobia inventory (SPIN) para a identificação de casos suspeitos de fobia social entre escolares adolescentes do município do Rio de Janeiro. Metodologia: 1) Versão do SPIN para o português. 2) Retrotradução. 3) Versão de consenso e realização de pré-teste. 4) Aplicação do questionário a 398 adolescentes de duas escolas do município do Rio de Janeiro. 5) Reteste com 190 alunos para estudo de confiabilidade, com estimativa do coeficiente de correlação intraclasse e Kappa ponderado, e análise de modelos log-lineares. 6) Validade de critério com aplicação do CIDI (Composite International Diagnostic Interview) - "padrão-ouro" - em uma amostra de 100 alunos. Resultados: A versão demonstrou boa consistência interna (alpha de cronbach=0,88); boa confiabilidade da pontuação total do instrumento, com coeficiente de correlação intraclasse igual a 0,78 e sem diferença estatisticamente significativa na estratificação pela maioria das variáveis. A confiabilidade das perguntas isoladas não foi tão boa (kappa ponderado variando de 0,32 a 0,65). Foram encontradas sensibilidade de 0,75 e especificidade de 0,57 para um ponto de corte no escore 19/20. Conclusão: A versão em português do SPIN exibiu propriedades psicométricas aceitáveis, com resultados de confiabilidade semelhantes aos obtidos na avaliação da versão original em inglês. Quanto a validade, observou-se uma menor especificidade.Introduction: Social Phobia is defined as extreme anxiety towards social situations, leading in many cases to consequences on social, academic and occupational functioning of the individual. It has been associated to a worse quality of life, substance abuse, depression and other mental disorders. It often has a chronic development with onset during adolescence. There is yet no self-reported instrument, validated for the Brazilian population, for the identification of this disorder. Objective: To translate and adapt to Portuguese the Social Phobia Inventory (SPIN), and to study its quality for the detection of suspected case of social phobia among teenager students in the city of Rio de Janeiro. Methodology: 1) Portuguese version of SPIN; 2) Back-translation; 3) Consensual version and pre-testing; 4) Application of questionnaire to 398 students in two schools in the city of Rio de Janeiro; 5) Retest with 190 students for reliability study with log-linear model analysis, estimates for intraclass correlation coefficient and weighted kappa; 6) Criterion validity against Composite International Diagnostic Interview (CIDI) - "gold-standard" - in a sample of 100 students. Results: The Portuguese version showed good internal consistency (Cronbach's alpha=0,88); good reliability for total score, with a intraclass correlation coefficient of 0,78 and no statiscally significant difference in stratification for most variables. Reliability for single items was not very good (weighted kappa between 0,32 and 0,65). Sensitivity of 0,75 and specificity of 0,57 were found for a cut-off point of 19/20. Conclusion: the Portuguese version of SPIN showed acceptable psychometric properties, and reliability results were similar to those obtained in the original English version. Validity evaluation showed a lower specificity

Confiabilidade da versão em Português do Inventário de Fobia Social (SPIN) entre adolescentes estudantes do Município do Rio de Janeiro Reliability of the Portuguese-language version of the Social Phobia Inventory (SPIN) among adolescent students in the city of Rio de Janeiro

Acredita-se que a fobia social teria início na adolescência e que precederia outros transtornos mentais, sendo importante a sua investigação nos jovens. Até o momento, não há nenhuma escala de fobia social validada para a nossa população. Neste estudo investigou-se a confiabilidade da versão em Português do Social Phobia Inventory (SPIN) entre escolares adolescentes da rede pública do Município do Rio de Janeiro. Após a versão do SPIN para o Português, conduziu-se um estudo de confiabilidade teste-reteste com 190 adolescentes de duas escolas, estimando-se os coeficientes de correlação intraclasse (CCIC), kappa ponderado (kw²) e ajuste de modelos log-lineares. Foram ainda construídos gráficos Bland & Altman. Observou-se uma boa consistência interna (a de Cronbach = 0,88) e boa confiabilidade da pontuação total do instrumento (CCIC = 0,78). A confiabilidade das perguntas isoladas não foi tão boa (kw² variando de 0,32 a 0,65). O modelo log-linear de melhor ajuste aos dados na maior parte dos itens foi o de "semi-associação". Esses achados nos permitiram concluir que a versão em português do SPIN exibiu resultados de boa confiabilidade, semelhantes aos da versão original em Inglês.It is believed that social phobia has its onset during adolescence and precedes other mental disorders; it is thus important to investigate the condition among young people. To date there is no self-reported scale validated for the Brazilian population. The present study investigated the reliability of the Portuguese-language version of the Social Phobia Inventory (SPIN) among adolescent students from public schools in the city of Rio de Janeiro. After SPIN was translated into Portuguese, a test-retest reliability study was carried out with 190 students. Intra-class correlation coefficient (ICC) and weighted kappa (kw²) were estimated, log-linear models were fitted, and Bland & Altman graphs were built. The Portuguese version showed good internal consistency (Cronbach's alpha = 0.88) and good reliability for total score (ICC = 0.78). Reliability for single items was not very good (kw² between 0.32 and 0.65). The "semi-association" model fit most of the items best. Based on these findings we concluded that the Portuguese-language version of SPIN showed good reliability results, similar to those obtained with the original English-language version

Confiabilidade da versão em Português do Inventário de Fobia Social (SPIN) entre adolescentes estudantes do Município do Rio de Janeiro

Acredita-se que a fobia social teria início na adolescência e que precederia outros transtornos mentais, sendo importante a sua investigação nos jovens. Até o momento, não há nenhuma escala de fobia social validada para a nossa população. Neste estudo investigou-se a confiabilidade da versão em Português do Social Phobia Inventory (SPIN) entre escolares adolescentes da rede pública do Município do Rio de Janeiro. Após a versão do SPIN para o Português, conduziu-se um estudo de confiabilidade teste-reteste com 190 adolescentes de duas escolas, estimando-se os coeficientes de correlação intraclasse (CCIC), kappa ponderado (kw²) e ajuste de modelos log-lineares. Foram ainda construídos gráficos Bland & Altman. Observou-se uma boa consistência interna (a de Cronbach = 0,88) e boa confiabilidade da pontuação total do instrumento (CCIC = 0,78). A confiabilidade das perguntas isoladas não foi tão boa (kw² variando de 0,32 a 0,65). O modelo log-linear de melhor ajuste aos dados na maior parte dos itens foi o de "semi-associação". Esses achados nos permitiram concluir que a versão em português do SPIN exibiu resultados de boa confiabilidade, semelhantes aos da versão original em Inglês

The Impact of Epidemic Violence on the Prevalence of Psychiatric Disorders in Sao Paulo and Rio de Janeiro, Brazil

Background Violence and other traumatic events, as well as psychiatric disorders are frequent in developing countries, but there are few population studies to show the actual impact of traumatic events in the psychiatric morbidity in low and middle-income countries (LMIC). Aims To study the relationship between traumatic events and prevalence of mental disorders in São Paulo and Rio de Janeiro, Brazil. Methods Cross-sectional survey carried out in 2007–2008 with a probabilistic representative sample of 15- to 75-year-old residents in Sao Paulo and Rio de Janeiro, Brazil, using the Composite International Diagnostic Interview. Results The sample comprised 3744 interviews. Nearly 90% of participants faced lifetime traumatic events. Lifetime prevalence of any disorders was 44% in Sao Paulo and 42.1% in Rio de Janeiro. One-year estimates were 32.5% and 31.2%. One-year prevalence of traumatic events was higher in Rio de Janeiro than Sao Paulo (35.1 vs. 21.7; p<0.001). Participants from Rio de Janeiro were less likely to have alcohol dependence (OR = 0.55; p = 0.027), depression (OR = 0.6; p = 0.006) generalized anxiety (OR = 0.59; p = 0.021) and post-traumatic stress disorder (OR = 0.62; p = 0.027). Traumatic events correlated with all diagnoses – e.g. assaultive violence with alcohol dependence (OR = 5.7; p<0.001) and with depression (OR = 1.7; p = 0.001)

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sj-csv-4-hpq-10.1177_13591053221120968 for The different impacts of COVID-19 on the mental health of distinct health care worker categories by Arthur Viana Machado, Raquel Menezes Gonçalves, Camila Monteiro Fabricio Gama, Liliane Maria Pereira Vilete, William Berger, Roberta Benitez Freitas Passos, Mauro Vito Mendlowicz, Gabriela Guerra Leal Souza, Mirtes Garcia Pereira, Izabela Mocaiber and Leticia de Oliveira in Journal of Health Psychology</p