Addressing Mental Health Needs in Low- and Middle-Income Countries: The case of São Caetano do Sul, Brazil.

São Caetano do Sul, a city in southeastern Brazil, boasts exemplary social indicators and healthcare services, with a population of 162,763 and a density of 9,736.03 inhabitants/km². Allocating 25% of its budget to healthcare, the city's mental healthcare services adhere to the National Mental Health Policy. Structured services include a CAPS-II, CAPS-AD, outpatient teams, and teams in various locations. Initiatives since 2000 include inaugurating a CAPS-AD in 2006, a psychiatric emergency service in 2010, and a CAPS-II in 2016, relocating CAPS-AD in 2019, and establishing the Cuca Legal Project in 2022. São Caetano do Sul has a Mental Health Risk Classification Protocol to aid clinical decision-making. Developing care lines for various groups, it offers programs like smoking prevention, school psychology, and obesity support. Collaborating with community centers, these facilities serve as teaching environments. The mental health care network focuses on five axes: Communication, Care, Prevention, Management, and Education, with specific proposed actions and competencies. Despite progress, challenges remain. Expanding access, reducing stigma, and implementing robust monitoring are crucial. São Caetano do Sul's experience offers valuable insights for similar urban settings in LMICs developing mental health programs.

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

Abstract 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.

The impact of child psychiatric conditions on future educational outcomes among a community cohort in Brazil.

AIMS: Mental health problems early in life can negatively impact educational attainment, which in turn have negative long-term effects on health, social and economic opportunities. Our aims were to: (i) estimate the impacts of different types of psychiatric conditions on educational outcomes and (ii) to estimate the proportion of adverse educational outcomes which can be attributed to psychiatric conditions. METHODS: Participants (N = 2511) were from a school-based community cohort of Brazilian children and adolescents aged 6-14 years enriched for high family risk of psychiatric conditions. We examined the impact of fear- (panic, separation and social anxiety disorder, specific phobia, agoraphobia and anxiety conditions not otherwise specified), distress- (generalised anxiety disorder, major depressive disorder and depressive disorder not otherwise specified, bipolar, obsessive-compulsive, tic, eating and post-traumatic stress disorder) and externalising-related conditions (attention deficit and hyperactivity disorder, conduct and oppositional-defiant conditions) on grade repetition, dropout, age-grade distortion, literacy performance and bullying perpetration, 3 years later. Psychiatric conditions were ascertained by psychiatrists, using the Development and Well-Being Behaviour Assessment. Propensity score and inverse probability weighting were used to adjust for potential confounders, including comorbidity, and sample attrition. We calculated the population attributable risk percentages to estimate the proportion of adverse educational outcomes in the population which could be attributed to psychiatric conditions. Analyses were conducted separately for males and females. RESULTS: Fear and distress conditions in males were associated with school dropout (odds ratio (OR) = 2.76; 95% confidence interval (CI) = 1.06, 7.22; p < 0.05) and grade repetition (OR = 2.76; 95% CI = 1.32, 5.78; p < 0.01), respectively. Externalising conditions were associated with grade repetition in males (OR = 1.66; 95% CI = 1.05, 2.64; p < 0.05) and females (OR = 2.03; 95% CI = 1.15, 3.58; p < 0.05), as well as age-grade distortion in males (OR = 1.66; 95% CI = 1.05, 2.62; p < 0.05) and females (OR = 2.88; 95% CI = 1.61, 5.14; p < 0.001). Externalising conditions were also associated with lower literacy levels (ß = -0.23; 95% CI = -0.34, -0.12; p < 0.001) and bullying perpetration (OR = 3.12; 95% CI = 1.50, 6.51; p < 0.001) in females. If all externalising conditions were prevented or treated, we estimate that 5.0 and 4.8% of grade repetition would not have occurred in females and males, respectively, as well as 10.2 (females) and 5.3% (males) of age-grade distortion cases and 11.4% of female bullying perpetration. CONCLUSIONS: The study provides evidence of the negative impact of psychiatric conditions on educational outcomes in a large Brazilian cohort. Externalising conditions had the broadest and most robust negative impacts on education and these were particularly harmful to females which are likely to limit future socio-economic opportunities.

Nationwide use of psychotropic drugs for treatment of self-reported depression in the Brazilian urban adult population.

OBJECTIVE: Antidepressant use is increasing worldwide, but national data on psychotropic drug use by depressed patients in Brazil is lacking. METHODOLOGY: Between 2013 and 2014, a representative sample of urban adult individuals were asked if they had a diagnosis of chronic disease, had a medical indication for drug treatment, and were taking chronic medications at the time for each reported diagnosis. We analyzed the frequencies of reported depression and the medications related to this disease. RESULTS: Overall, 6.1% of respondents reported depression. The prevalence increased with age - 9.5% among the elders - was higher among women (8.9%) and in the south of the country (8.9%). As a single disease, the prevalence of depression was higher among young people (17.6%). Among those with multimorbidity, the prevalence of depression rose to 25.7%. Of those who reported depression, 81.3% had medical indication for treatment and 90.3% were under treatment - this proportion was lower among young people (84.5%) and those living in the poorest region (78.6%). Antidepressants accounted for 47.2% of psychotropic drugs taken by respondents with depression, with regional differences - only 30% used antidepressants in the North. Polypharmacy was reported by 22% of those with depression and other chronic diseases. CONCLUSION: Depression in Brazil, is common among young adults as a single chronic disease and highly prevalent among people with chronic multimorbidity, especially the young. The treatment gap was larger among young people and in the less developed regions of the country.

Domestic violence and risk of internalizing and externalizing problems in adolescents living with relatives displaying substance use disorders / Violência doméstica e risco de problemas de internalização e externalização em adolescentes com familiares apresentando transtornos por uso de substâncias

OBJECTIVE: To investigate the association between exposure to domestic violence and increased risk of internalizing and externalizing problems and substance use among adolescents living with relatives with substance use disorder (SUD) at a low-income community of São Paulo, Brazil. METHODS: A crosssectional study was conducted with 102 adolescents aged 12-17 years (M = 14.2, SD = 1.7) who were living with relatives suffering from SUD. Outcomes were measured using the Youth Self-Report (YSR), psychosocial stress factors questionnaire, Drug Use Screening Inventory (DUSI) and Phrase Inventory of Intrafamily Child Abuse (PIICA). RESULTS: The sample presented high prevalence of emotional/behavioral problems with YSR's scores in the clinical range for Internalizing Problems (24.5%), Externalizing Problems (21.6%), and Total Problems (26.5%). The presence of mental health problems predicted substance use (PR = 2.22; 95% CI = 1.2-4.13), and substance use predicted increased risk of mental health problems. Alcohol use predicted more than double the risk of emotional/behavioral problems (PR = 2.01; 95% CI = 1.08-3.76), while illicit drug use was associated with an almost threefold increase in the prevalence of Internalizing (PR = 2.87; 95% CI = 1.19-6.89) and Externalizing Problems (PR = 3.3; 95% CI = 1.35-8.04). CONCLUSION: Adolescents of relatives with SUD are at risk of developing emotional and behavioral problems. These findings reinforce the need to develop public mental health policies, which include protective interventions to adolescents living in families affected by substance use disorders.

OBJETIVO: Investigar a associação entre exposição à violência doméstica e aumento do risco de problemas internalizantes e externalizantes e uso de substâncias entre adolescentes que vivem em famílias com transtorno por uso de substâncias (TUS) em uma comunidade de baixa renda de São Paulo, Brasil. MÉTODOS: Estudo transversal com 102 adolescentes de 12 a 17 anos (M = 14,2, DP = 1,7) que vivem com familiares com TUS. Os desfechos foram avaliados por meio do Inventário de Autoavaliação para Adolescentes (YSR), questionários de fatores de estresse psicossociais, Drug Use Screening Inventory (DUSI) e Inventário de Frases de Violência Doméstica (IFVD). RESULTADOS: A amostra apresentou altas taxas de problemas emocionais/comportamentais no YSR, sendo 24,5% com escores na faixa clínica para Problemas Internalizantes, 21,6% para Problemas Externalizantes e 26,5% para Problemas Totais. A presença de problemas de saúde mental foi preditora do uso de substâncias (RP = 2,22; IC 95% = 1,2-4,13) e o uso de substâncias foi preditor do aumento da prevalência de problemas emocionais/comportamentais. O uso de álcool prediz mais do que o dobro do risco de problemas emocionais/comportamentais (RP = 2,01; IC 95% = 1,08-3,76), enquanto o uso de substâncias ilícitas esteve associado com um aumento de quase três vezes na prevalência de Problemas Internalizantes (RP = 2,87; IC 95% = 1,19-6,89) e Externalizantes (RP = 3,3; IC 95% = 1,35-8,04). CONCLUSÃO: Adolescentes que convivem diretamente com familiares com TUS estão em risco para o desenvolvimento de problemas emocionais/comportamentais. Os achados reforçam a necessidade de políticas públicas que incluam programas de proteção para adolescentes que vivem em famílias com transtornos causados pelo uso de substâncias.

Nationwide use of psychotropic drugs for treatment of self-reported depression in the Brazilian urban adult population / Uso nacional de drogas psicotrópicas no tratamento da depressão autorreferida na população adulta urbana brasileira

ABSTRACT: Objective: Antidepressant use is increasing worldwide, but national data on psychotropic drug use by depressed patients in Brazil is lacking. Methodology: Between 2013 and 2014, a representative sample of urban adult individuals were asked if they had a diagnosis of chronic disease, had a medical indication for drug treatment, and were taking chronic medications at the time for each reported diagnosis. We analyzed the frequencies of reported depression and the medications related to this disease. Results: Overall, 6.1% of respondents reported depression. The prevalence increased with age - 9.5% among the elders - was higher among women (8.9%) and in the south of the country (8.9%). As a single disease, the prevalence of depression was higher among young people (17.6%). Among those with multimorbidity, the prevalence of depression rose to 25.7%. Of those who reported depression, 81.3% had medical indication for treatment and 90.3% were under treatment - this proportion was lower among young people (84.5%) and those living in the poorest region (78.6%). Antidepressants accounted for 47.2% of psychotropic drugs taken by respondents with depression, with regional differences - only 30% used antidepressants in the North. Polypharmacy was reported by 22% of those with depression and other chronic diseases. Conclusion: Depression in Brazil, is common among young adults as a single chronic disease and highly prevalent among people with chronic multimorbidity, especially the young. The treatment gap was larger among young people and in the less developed regions of the country.

RESUMO: Objetivo: O uso de antidepressivos está aumentando em todo o mundo, mas faltam dados nacionais sobre o uso de drogas psicotrópicas por pacientes deprimidos no Brasil. Metodologia: Entre 2013 e 2014, uma amostra representativa de indivíduos adultos urbanos foi questionada sobre a presença diagnóstica de doença crônica, a indicação médica para tratamento medicamentoso e o uso de medicamentos crônicos à época de cada diagnóstico relatado. Foram analisadas as frequências de depressão relatada e os medicamentos relacionados a essa doença. Resultados: No geral, 6,1% dos entrevistados relataram depressão. A prevalência aumentou com a idade (9,5% entre os idosos) foi maior entre as mulheres (8,9%) e no sul do país (8,9%). Como doença única, a prevalência de depressão foi maior entre os jovens (17,6%). Entre aqueles com multimorbidade, a prevalência de depressão subiu para 25,7%. Dos que relataram depressão, 81,3% tinham indicação médica para tratamento e 90,3% estavam em tratamento - essa proporção foi menor entre os jovens (84,5%) e os que moram na região mais pobre (78,6%). Os antidepressivos representaram 47,2% dos medicamentos psicotrópicos tomados pelos entrevistados com depressão, com diferenças regionais - apenas 30% usavam antidepressivos no Norte. Polifarmácia foi relatada por 22% das pessoas com depressão e outras doenças crônicas. Conclusão: A depressão no Brasil é comum entre adultos jovens como doença crônica única e altamente prevalente entre as pessoas com multimorbidade crônica, principalmente os jovens. A lacuna de tratamento foi maior entre os jovens e nas regiões menos desenvolvidas do país.

Contingency management is effective in promoting abstinence and retention in treatment among crack cocaine users with a previous history of poor treatment response: a crossover trial

Background: Crack use has become a severe health problem in Brazil. Contingency management has shown robust evidence of efficacy in the treatment of cocaine use disorder (CUD) in high-income countries; however, it is still unclear how this intervention can impact treatment in low-income countries. Objective: To evaluate the efficacy of contingency management in the treatment of CUD among individuals with a previous history of poor treatment response in Brazil. Methods: Six months after the end of treatment, 32 participants previously allocated to the usual care condition (UCC) were invited to receive an additional 12 weeks of treatment in a contingency management condition (CMC), and 16 accepted the invitation. We compared data obtained from only the 16 participants (14 male) exposed to both treatment conditions. Results: Participants attended more treatment sessions and were retained in treatment for a longer period during the CMC than during the UCC (p < .01 for both). The proportion of negative cocaine samples submitted, the mean longest duration of cocaine abstinence, and the odds of being abstinent from cocaine during the 12 weeks of treatment were significantly higher during treatment in the CMC when compared to the UCC (p < .05). Conclusions: This study provides further evidence that contingency management is effective in promoting abstinence and retention in treatment among individuals with CUD with a history of poor treatment response. Our findings argue for the incorporation of CM among public treatment services for CUD in Brazil. Trial registration: This study was registered at ClinicalTrials.gov as NCT01815645 on March 21, 2013.

Dor lombar e transtornos mentais comuns na Estratégia Saúde da Família: uma associação pouco reconhecida / Low back pain and common mental disorders in Family Health Strategy: an association little recognized / Dolor lumbar y trastornos mentales comunes en la Estrategia Salud de la Familia: una asociación poco reconocida

Objetivo: Descrever o perfil sociodemográfico dos pacientes atendidos na Estratégia Saúde da Família de quatro capitais brasileiras (Rio de Janeiro, São Paulo, Porto Alegre e Fortaleza) com dor lombar e investigar a associação entre dor lombar e depressão, ansiedade e somatização. Métodos: Estudo de corte transversal com 1857 pacientes atendidos nos anos de 2009 (setembro a novembro) e 2010 (junho a agosto). Instrumentos: rastreio de somatização (SOMS-2), avaliação de ansiedade e depressão (HAD), Questionário Geral do Paciente, para dados sociodemográficos e o Formulário do Profissional Assistente, com as informações referentes as consultas. A dor lombar foi analisada a partir da frequência de três diferentes formas de apresentação: queixa autorreferida pelo paciente, sintoma registrado pelo médico e diagnóstico de lombalgia confirmado pelo médico. Resultados: 77,3% eram mulheres com mais de quatro anos de estudo e renda per capita inferior a um salário mínimo e meio. Encontramos associação significativa de queixa de dor lombar com ansiedade (OR=1,5, 95% IC 1,02-2,16) e somatização (OR=1,8, 95% IC 1,12-2,88), mas não com depressão. Pacientes que apresentavam queixa de dor lombar, porém sem registro do sintoma pelo médico, apresentaram associações ainda mais fortes com ansiedade (OR=1,6, 95% IC 1,03-2,63) e somatização (OR=2,3, 95% IC 1,33-3,99). A confirmação do diagnóstico de dor lombar pelo médico não se associou significativamente com nenhum transtorno. Conclusão: Considerando a dor lombar como uma das queixas de maior prevalência na Atenção Primária e sua associação significativa com ansiedade e somatização, recomenda-se a abordagem da ansiedade e somatização em pacientes com queixa de dor lombar.

Objective: To describe the demographic profile of the patients assisted in the Family Health Strategy of four Brazilian capitals (Rio de Janeiro, São Paulo, Porto Alegre and Fortaleza) with low back pain and investigate the association between low back pain and depression, anxiety and somatization. Methods: Cross-sectional study with 1857 patients served in the years 2009 (September to November) and 2010 (June to August). Instruments: Screening of somatization (SOMS-2), evaluation of anxiety and depression (HAD), General Questionnaire of the Patient, for sociodemographic data and the Form of the Professional Assistant, with the information regarding the consultations. The low back pain was analyzed from the frequency of three different forms of presentation: auto reference complaint by the patient, symptom recorded by the doctor and diagnosis of backache confirmed by the doctor. Results: 77.3% were women with more than four years of study and per capita income less than a minimum wage and a half. We found significant association of low back pain complaints with anxiety (OR=1.5, 95% IC 1,02-2,16) and somatization (OR=1.8, 95% IC 1,12-2,88) but not with depression. Patients who complained of low back pain, but there was no record of the symptom by the doctor, presented even stronger associations with anxiety (OR=1.6, 95% IC 1,03-2,63) and somatization (OR=2.3, 95% IC 1,33-3,99). Confirmation of the diagnosis of low back pain by the doctor has not been associated significantly with any disorder. Conclusion: Considering low back pain as one of the most prevalence complaints in Primary Care and its significant association with anxiety and Somatization, it is recommended to approach anxiety and somatization in patients with a complaint of low back pain.

Objetivo: Describir el perfil demográfico de los pacientes asistidos en la Estrategia Salud de la Familia de cuatro capitales brasileño (Rio de Janeiro, São Paulo, Porto Alegre y Fortaleza) con dolor lumbar e investigar la asociación entre el dolor lumbar y la depresión, ansiedad y somatización. Métodos: Estudio transversal con 1857 pacientes atendidos en los años 2009 (septiembre a noviembre) y 2010 (junio a agosto). Instrumentos: seguimiento de la somatización (SOMS-2), evaluación de la ansiedad y depresión (HAD), Cuestionario General del Paciente, para datos sociodemográficas y el Reporte del Profesional Asistente, con la información relativa a las consultas. El dolor lumbar fue analizado a partir de la frecuencia de tres diversas formas de presentación: queja auto-referida por el paciente, síntoma registrado por el médico y diagnosis del lumbago confirmado por el médico. Resultados: 77,3% fueron mujeres con más de cuatro años de estudio y renta per cápita menos de un salario mínimo y medio. Encontramos la asociación significativa de queja del dolor lumbar con la ansiedad (RM=1,5, el 95% IC 1,02-2,16) y somatización (RM=1,8, el 95% IC 1,12-2,88) pero no con la depresión. Los pacientes que se quejaron de dolor lumbar, pero no había registro del síntoma por el médico, presentaron asociaciones incluso más fuertes con la ansiedad (RM=1,6, el 95% IC 1,03-2,63) y somatización (RM=2,3, el 95% IC 1,33-3,99). La confirmación del diagnóstico de dolor lumbar por el médico no se ha asociado significativamente con ningún trastorno. Conclusión: Considerando el dolor lumbar como una de las quejas prevalentes de la mayoría en la Atención Primaria y su asociación significativa con la ansiedad y la somatización, se recomienda abordar a la ansiedad y a la somatización en pacientes con quejas de dolor lumbar.

Padrões de Apoio Social na Atenção Primária à Saúde: diferenças entre ter doenças físicas ou transtornos mentais / Social Support patterns in Primary Health Care: differences between having physical diseases or mental disorders

Resumo A rede de apoio é considerada um agente protetor da saúde em seus aspectos físico, mental e psicológico, proporcionando melhor qualidade de vida, favorecendo adaptação à condições adversas, promovendo resiliência e a mobilização de recursos no enfrentamento de eventos de vida negativos que podem levar ao adoecimento. O nosso objetivo foi estudar a relação entre doenças físicas, transtorno mental comum e a rede de apoio social dos pacientes atendidos na Atenção Primária à Saúde no Rio de Janeiro e São Paulo em um estudo de corte transversal com 1466 pacientes entre 18 e 65 anos. Para aferir o tipo de rede de apoio foi utilizado o Índice de Rede Social por meio das categorias: isolamento e integração. Para aferir o diagnóstico de doença física foi utilizado o questionário pelo médico/enfermeiro e para detecção dos transtornos mentais foi utilizado o Hospital Anxiety and Depression Scale. Verificou-se que o padrão da rede de apoio foi diferente entre as doenças físicas e os transtornos mentais. Foram detectadas associações negativas entre diabetes e isolamento; integração e ansiedade; integração e depressão e associações positivas do isolamento com ansiedade e isolamento e depressão.

Abstract The social support network is a health protective factor involving physical, mental and psychological aspects, providing a better quality of life, favoring better adaptation to adverse conditions, promoting resilience and mobilizing resources for a more effective coping with negative life events that can lead to illness. We aimed to analyze the association between physical diseases, common mental disorders and the social support network of patients serviced at primary care facilities in the cities of Rio de Janeiro and São Paulo through a cross-sectional study with 1,466 patients in the 18-65 years age group. We used the Social Network Index (SNI) to assess the support network through the categories of isolation and integration. The doctor/nurse completed the questionnaire to evaluate the physical disease diagnosis, while the Hospital Anxiety and Depression Scale was used to detect mental disorders. We found that the pattern of social support was different depending on the presence of physical diseases or mental disorders. Negative associations were found between diabetes and isolation; integration and anxiety; integration and depression. Positive associations were identified between isolation and anxiety and isolation and depression.

Word Decoding Task: Item Analysis by IRT and Within-Group Norms / Tarefa de Decodificação: Análise de Itens pela TRI e Normas Intragrupo

Abstract This paper reports the performance of a representative sample of 747 students (52.5% female), from 2nd to 5th year of elementary education from private and public (83.8%) schools of Sao Paulo city. The children performed the Form A of Word Reading and Spelling Task (WRST) containing 48 low-frequency words presented in a card. Data were analyzed using models of Item Response Theory. We observed high levels of accuracy. The analysis selected 24 items, which presented low to moderate discrimination and difficulty indices. There were mean differences between grades, but not sex or school type. We report percentile norms for the grades for the WRST´S (Form) Reduced Version. The results support preceding studies with the word decoding tasks in Brazilian Portuguese, which attested to the quasi-regular character of that language.

Resumo O estudo investiga o desempenho de uma amostra representativa de crianças (52,5% meninas) cursando do 2º ao 5º ano de escolas particulares e públicas (83,8%) de São Paulo (N = 747). As crianças leram em voz alta a Forma A da Prova de Leitura e de Escrita de Palavras (PLEP), constituída de 48 palavras de baixa frequência, apresentadas em um cartão. Os dados foram analisados utilizando modelos da Teoria de Resposta ao Item. Observaram-se altos índices de acurácia. Foram selecionados 24 itens, os quais apresentaram, em média, índices de discriminação e de dificuldade de baixos a moderados. Houve efeito de escolaridade, mas não de sexo ou tipo de escola. Normas em percentis foram reportadas para a versão reduzida da Forma A da PLEP. Os resultados condizem com estudos que utilizaram tarefas de decodificação de palavras no Brasil e atestam para o caráter quase-regular do idioma.

Burnout syndrome and coping strategies in Portuguese oncology health care providers

Abstract Background Burnout is a multidimensional syndrome and includes symptoms of emotional exhaustion, depersonalization, and reduced personal accomplishment at work. Oncology health care providers are at high risk to develop symptoms of burnout because of work-related stressors. Adaptive coping strategies adopted to deal with stressors may prevent the development of burnout. Objective The present study aims to assess the association between burnout, functional coping strategies, and occupational factors in a sample of oncology providers, mostly nurses. Methods Sociodemographic Questionnaire, the Maslach Burnout Inventory, and the Problem Solving Inventory "Inventário de Resolução de Problemas" were administered. Descriptive, correlational, and linear regression analyses were performed. Results The study showed that emotional exhaustion correlated with lower levels of adaptive coping, less years of experience in Oncology, and a greater amount of hours worked per week. Personal accomplishment was associated with the adaptive coping strategies. No further statistically significant associations were identified. Discussion Our findings support the importance of adaptive coping strategies in order to prevent symptoms of burnout when health professionals face potentially stressful occupational factors. Training aimed at improving adaptive coping skills may prevent burnout syndrome for health care professionals working in Oncology.

Paraphilic Thoughts, Behaviors and Sex Addiction in a Sample of Persons Who Use Drugs: A Cross-Sectional Study.

OBJECTIVE: The aim of this study was to evaluate the prevalence of paraphilic thoughts/behaviors (including paraphilic disorders) with and without sexual addiction and sexual-related conditions in a sample of substance disorder patients. METHODS: This was a cross-sectional study of substance-dependent individuals who sought outpatient treatment in São Paulo, Brazil. Data included sociodemographic information, drug of choice, responses to questions about sexual behavior, and to the following standardized questionnaires: (a) Sexual Addiction Screening Test, and (b) Childhood Trauma Questionnaire. RESULTS: The sample comprised 134 persons who use drug, predominantly men (76.1%), 39.6% were aged between 18 and 29 years, and 54.9% were single. Most were persons who use polydrug, 73.9% were alcohol and cocaine users, 63.4% marijuana users, 81.1% tobacco users, and 5.2% steroid users. Prevalence of paraphilic thoughts/behaviors (including paraphilic disorders) with and without sexual addiction was 47%. The HPV/herpes and hepatitis B rates were 7.9% (P = 0.021) and 6.3% (P = 0.046) respectively. Paraphilic and nonparaphilic thoughts/behaviors were associated to the presence of childhood physical neglect (odds ratios [OR] = 4.7, 95% confidence interval [CI] 1.0 to 21.9), low educational level (OR = 7.2, 95% CI 1.4 to 36), heterosexuality (OR = 3.8, 95% CI 1.1 to 12.8) and youth (age 18 to 20 years) (OR = 5.6, 95% CI 1.4 to 11.8). CONCLUSIONS: The high prevalence of paraphilic thoughts/behaviors with or without sex addiction in persons who use drugs may be related to the experience of physical and emotional neglect during childhood and this possibility should routinely be investigated in clinical practice.

Erectile Dysfunction Symptoms in Polydrug Dependents Seeking Treatment.

OBJECTIVE: To assess erectile dysfunction (ED) symptom prevalence, sexual behavior conditions, and risk factors associated to ED in a male polydrug dependent sample. METHODS: A cross-sectional design study was conducted with 102 substance-dependent male polydrug users who sought outpatient treatment in São Paulo, Brazil. Sociodemographic data, drug of choice, chronic disease questions, sexually transmitted infections, International Index of Erectile Function (IIEF) scale, Sexual Addiction Screening Test (SAST), and WHOQOL-Bref instrument were used. RESULTS: The erectile dysfunction prevalence was 32.3% and it was related to the marital status (single) (p < 0.001), occupational status (fully unemployed) (p < 0.001), presenting a chronic disease (p = 0.027), and with types of sexual partnerships (occasional partner) (p < 0.001). Alcohol (73.5%), tobacco (79.4%), cannabis (83.3%), and cocaine (snorted 78.4% and smoked 42.2%) were the drugs of choice. The ED risk decreased when marital status was married (odds ratio = 3.2 CI95% 1.411-7.518) and with chronic disease (odds ratio 0.06 CI95% 0.00-0.97), while having occasional sexual partners increased 14 times ED risk (OR 14.0 CI95%1.62-122.18). There were no significant associations between quality of life, DOC and ED. CONCLUSION: Approximately one third of the substance dependents in this sample presented ED. There is a need to integrate psychiatric and clinical care in substance treatment services, and to improve the provision of sexual health care and support available for this population.

Qualidade de vida em pacientes da atenção primária do Rio de Janeiro e São Paulo, Brasil: associações com eventos de vida produtores de estresse e saúde mental / Quality of life of primary care patients in Rio de Janeiro and SãoPaulo, Brasil: associations with stressful life events and mental health

Resumo A qualidade de vida (QV) é um constructo subjetivo, que pode ser associado negativamente a fatores como os transtornos mentais e os eventos de vida produtores de estresse (EVPE). O objetivo deste artigo é identificar a associação entre variáveis demográficas, socioeconômicas, transtorno mental comum, sintomas sugestivos de ansiedade e depressão, EVPE com QV na Atenção Primária (AP). Estudo transversal realizado com 1.466 pacientes atendido na AP, nos munícipios de São Paulo e Rio de Janeiro, em 2009 e 2010. Realizou-se análise bivariada por meio do Teste-t e regressão linear múltipla para cada domínio de QV. Os escores de QV para os domínios físico, psicológico, relações sociais e meio ambiente foram, respectivamente de, 64,7, 64,2, 68,5 e 49,1. Pela análise multivariada foram encontradas associações do domínio físico com os problemas de saúde e discriminação, do psicológico com discriminação, das relações sociais com problemas financeiros/estruturais, causas externas e problemas de saúde, e do meio ambiente com problemas financeiros/estruturais, causas externas e discriminação. As variáveis de saúde mental, os problemas de saúde e os problemas/financeiros estruturais foram os que se associaram negativamente à QV.

Abstract Quality of life (QoL) is a subjective construct, which can be negatively associated with factors such as mental disorders and stressful life events (SLEs). This article seeks to identify the association between socioeconomic and demographic variables, common mental disorders, symptoms suggestive of depression and anxiety, SLEs with QoL in patients attended in Primary Care (PC). It is a transversal study, conducted with 1,466 patients attended in PC centers in the cities of São Paulo and Rio de Janeiro in 2009 and 2010. Bivariate analysis was performed using the T-test and four multiple linear regressions for each QoL domain. The scores for the physical, psychological, social relations and environment domains were, respectively, 64.7; 64.2; 68.5 and 49.1. By means of multivariate analysis, associations of the physical domain were found with health problems and discrimination; of the psychological domain with discrimination; of social relations with financial/structural problems; of external causes and health problems; and of the environment with financial/structural problems, external causes and discrimination. Mental health variables, health problems and financial/structural problems were the factors negatively associated with QoL.

Social support network, mental health and quality of life: a cross-sectional study in primary care / Rede de apoio social, saúde mental e qualidade de vida: um estudo transversal na atenção primária / Red de apoyo social, salud mental y calidad de vida: un estudio transversal en la atención primaria

The objective of this study was to identify the association between emotional distress and social support networks with quality of life in primary care patients. This was a cross-sectional study involving 1,466 patients in the cities of São Paulo and Rio de Janeiro, Brazil, in 2009/2010. The General Health Questionnaire, the Hospital Anxiety and Depression Scale and the brief version of the World Health Organization Quality of Life Instrument were used. The Social Support Network Index classified patients with the highest and lowest index as socially integrated or isolated. A bivariate analysis and four multiple linear regressions were conducted for each quality of life outcome. The means scores for the physical, psychological, social relations, and environment domains were, respectively, 64.7; 64.2; 68.5 and 49.1. In the multivariate analysis, the psychological domain was negatively associated with isolation, whereas the social relations and environment domains were positively associated with integration. Integration and isolation proved to be important factors for those in emotional distress as they minimize or maximize negative effects on quality of life.

O estudo teve como objetivo identificar a associação entre sofrimento emocional e redes de apoio social com qualidade de vida em pacientes de atenção primária. O estudo transversal incluiu 1.466 pacientes nas cidades de São Paulo e Rio de Janeiro, Brasil, entre 2009 e 2010. Foram utilizados o General Health Questionnaire, a Hospital Anxiety and Depression Scale e a versão breve do World Health Organization Quality of Life Instrument. O Índice de Redes Sociais de Apoio classificou os pacientes com as pontuações mais altas e baixas como sendo socialmente integrados ou isolados, respectivamente. Para cada resultado de qualidade vida, foram realizadas uma análise bivariada e quatro regressões lineares múltiplas. As médias para os domínios físico, psicológico, social e ambiental foram, respectivamente: 64,7; 64,2; 68,5 e 49,1. Na análise multivariada, o domínio psicológico mostrou associação negativa com o isolamento, enquanto os domínios social e ambiental foram associados positivamente com a integração. A integração e o isolamento apareceram como fatores importantes para aqueles com sofrimento emocional, já que minimizam ou maximizam os efeitos negativos sobre qualidade de vida.

El estudio tuvo como objetivo identificar la asociación entre sufrimiento emocional y redes de apoyo social con la calidad de vida en pacientes de atención primaria. El estudio transversal incluyó a 1.466 pacientes en las ciudades de São Paulo y Río de Janeiro, Brasil, entre 2009 y 2010. Se utilizaron el General Health Questionnaire, la Hospital Anxiety and Depression Scale y la versión breve del World Health Organization Quality of Life Instrument. El Índice de Redes Sociales de Apoyo clasificó a los pacientes con las puntuaciones más altas y bajas como estando socialmente integrados o aislados, respectivamente. Para cada resultado de calidad vida, se realizó un análisis bivariado y cuatro regresiones lineales múltiples. Las medias para los dominios físico, psicológico, social y ambiental fueron, respectivamente: 64,7; 64,2; 68,5 y 49,1. En el análisis multivariado, el dominio psicológico mostró una asociación negativa con el aislamiento, mientras los dominios social y ambiental se asociaron positivamente con la integración. La integración y el aislamiento aparecieron como factores importantes para aquellos con sufrimiento emocional, ya que minimizan o maximizan los efectos negativos sobre la calidad de vida.

Culture-bound syndromes in Spanish speaking Latin America: the case of Nervios, Susto and Ataques de Nervios

Abstract Background Cultural issues are important for diagnostic validity between different countries; little has been addressed from Latin America and Caribbean countries (LAC). Objective To identify LAC studies on culture-bound syndromes (CBS) and extract potential empirical evidence about Susto,Nervios and Ataques de Nervios. Methods Search strategies were carried out in Medline, Embase, Lilacs, ISI and PsycINFO, covering 1992 to 2015. Inclusion criteria studies on CBS conducted on populations residing in LAC, LAC articles on diagnostic classification and culture, where LAC has been included. Exclusion criteria studies on Latin American migrants outside LAC. Content analysis used the system proposed by Guarnaccia and Rogler (1999): epidemiological, ethnographic and socio-demographic data and identification of comorbidities with other psychiatric disorders. Results Thirty one articles were selected out of 1.090. These CBS were selected out of 1aphic data and identification of comorbidities with other ps proposed by Guarnaccia diagnostic classification and cun panic disorders and post-traumatic stress disorder and presented more psychosocial vulnerability. Discussion Analysis showed that Nervios, Susto andAtaques de Nervios are important idioms of distress, associated with socio-economically vulnerable populations and comorbidities with other psychiatric conditions, particularly post-traumatic stress disorder. More studies are needed on their relation with stress and in more LAC countries.