Mental Health and Emotional Disorders During the COVID-19 Pandemics: Prevalence and Extent in PICU Staff.

OBJECTIVES: To assess the prevalence of burnout, anxiety and depression symptoms, and posttraumatic stress disorder (PTSD) in PICU workers in Brazil during the first peak of the COVID-19 pandemic. To compare the results of subgroups stratified by age, gender, professional category, health system, and previous mental health disorders. DESIGN: Multicenter, cross-sectional study using an electronic survey. SETTING: Twenty-nine public and private Brazilian PICUs. SUBJECTS: Multidisciplinary PICU workers. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Self-reported questionnaires were used to measure burnout (Maslach Burnout Inventory), anxiety and depression (Hospital Anxiety and Depression Scale), and PTSD (Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [PCL-5]) in 1,084 respondents. Subjects were mainly young (37.1 ± 8.4 yr old) and females (85%), with a median workload of 50 hours per week. The prevalence of anxiety and depression was 33% and 19%, respectively, whereas PTSD was 13%. The overall median burnout scores were high in the emotional exhaustion and personal accomplishment dimensions (16 [interquartile range (IQR), 8-24] and 40 [IQR, 33-44], respectively) whereas low in the depersonalization one (2 [IQR, 0-5]), suggesting a profile of overextended professionals, with a burnout prevalence of 24%. Professionals reporting prior mental health disorders had higher prevalence of burnout (30% vs 22%; p = 0.02), anxiety (51% vs 29%; p < 0.001), and depression symptoms (32.5% vs 15%; p < 0.001), with superior PCL-5 scores for PTSD ( p < 0.001). Public hospital workers presented more burnout (29% vs 18.6%, p < 0.001) and more PTSD levels (14.8% vs 10%, p = 0.03). Younger professionals were also more burned out ( p < 0.05 in all three dimensions). CONCLUSIONS: The prevalence of mental health disorders in Brazilian PICU workers during the first 2020 peak of COVID-19 was as high as those described in adult ICU workers. Some subgroups, particularly those reporting previous mental disorders and younger professionals, should receive special attention to prevent future crises.

Structural validity of the Conflict in Adolescent Dating Relationships Inventory (CADRI): A reduced version for use on respondents as victims and perpetrators.

OBJECTIVES: To evaluate CADRI's configural and metric structures and explore its performance from the perspective of the respondents as perpetrators and victims. In the process, we present shorter versions for both roles. METHODS: The sample consisted of 561 adolescents aged 15 and 19, enrolled in public and private schools in Rio de Janeiro, Brazil. Initially, confirmatory factor analyzes (CFA) tested the originally proposed dimensional structure. Since this model was rejected, the second step analyzed the data via Exploratory Structural Equation Models (ESEM) to reassess the instrument's structure. Applying a decision algorithm on a new dimensional structure, we proceeded to reduce the number of items to establish separate sets for victimization and perpetration. These final models were then analyzed via CFA to assess their psychometric properties. RESULTS: The final solutions contained 15 items comprising four and three factors for victimization and perpetration, respectively. Thirteen items were common to both models, but two were unique to their respective sets. Regardless of their small differences, the final solutions fitted adequately, held factorial item pertinence and unambiguity, contained reliable and non-redundant items, and sustained factor-based convergent and discriminant validities. CONCLUSION: The four and three-factor models were within the dimensional bounds proposed in the original CADRI, the shorter scales still succeeding in partially capturing what was envisaged in the first version of the instrument. However, the shorter versions suggested here are still tentative, thus requiring further examination.

The Role of Income on the Relationship Between the Brazilian Cash Transfer Program (Programa Bolsa Família) and Intimate Partner Violence: Evidence From a Multigroup Path Analysis.

Several initiatives are being proposed to reduce the incidence of intimate partner violence (IPV) worldwide. Actions aimed at women's economic empowerment through income transfer programs are one of those. Still, the literature on their impact is scarce and controversial. This study attempts to shed some light on this matter assessing whether the Brazilian Conditional Cash Transfer Program (Programa Bolsa Família [PBF]) is a protective factor for psychological and physical IPV against women in families of different levels of income. This is a cross-sectional, household-based study conducted in the city of Duque de Caxias, Rio de Janeiro, Brazil. The sample comprised 807 women reporting some intimate relationship in the 12 months before the interview. Information on IPV and participation on PBF were collected through face-to-face interviews using the Revised Conflict Tactics Scales (CTS2) and a direct question, respectively. A multigroup path analysis was applied to study the relations between PBF and psychological and physical IPV, considering confounding factors, some mediators, and moderation by income. The prevalence of both psychological and physical IPV are high, be it in the poverty and the extreme poverty income strata (psychological IPV: 66.2% and 72.7%, respectively; physical IPV: 26.2% and 40.6%, respectively). Results also showed a positive and direct association between PBF and psychological violence, yet only among families above the poverty line (ß = .287, p = .001). The same could be found regarding physical violence, but the effect of PBF was indirect, mediated by psychological violence (ß = .220, p = .003). Findings suggest that actions aimed at preventing IPV should go hand in hand with the PBF and, perhaps, other income transfer programs. This is even more relevant in relation to the less extreme poverty group where cash transfer may further raise conflicts and violence.

Childhood abuse and community violence: Risk factors for youth violence.

OBJECTIVE: To investigate the joint effect of child abuse and neglect (CAN) and community violence (CV) on adolescents with peers that commit youth violence (YV). METHODS: This is a school-based cross-sectional study of 699 students enrolled in four public and nine private schools in the municipality of Rio de Janeiro, Brazil. Participants were selected through a complex cluster sampling procedure. CAN was identified using the Childhood Trauma Questionnaire (CTQ). Exposure to CV was assessed by asking students if they have witnessed cases of lethal violence in the community. YV was measured indirectly through questions about having friends who have committed acts of crime. Multivariate logistic models were used to study the effects of emotional, physical, and sexual abuse and emotional and physical neglect in childhood on YV, controlled for confounders, according to different levels of CV. RESULTS: Emotional abuse OR = 3.32 (CI 95%: 1.79-6.17), sexual abuse OR = 2.33 (CI 95%: 1.20-4.54), and physical neglect OR = 1.81 (CI 95%: 1.02-3.20) increased the odds of YV in adolescents, whether cooccurring with CV or not. Physical abuse OR = 3.95 (CI 95%: 2.29 - 6.80) and emotional neglect OR = 2.93 (CI 95%: 1.83-4.72) are only risk factors for YV involvement when associated with CV. CONCLUSIONS: These findings highlight the relevance of CAN and CV as risk factors for YV and the potential increase in adolescents' vulnerability when exposed to both. Policies aiming at preventing and dealing with CAN are essential strategies to reduce YV, especially in areas with high levels of CV.

[Magnitude and characterization of sexual coercion experienced by young adults in three Brazilian state capitals: Porto Alegre, Rio de Janeiro, and Salvador]. / Magnitude e caracterização de situações de coerção sexual vivenciadas por jovens de três grandes capitais brasileiras: Porto Alegre, Rio de Janeiro e Salvador.

The article estimates the magnitude of sexual coercion among young adults in three large Brazilian cities. In addition to evaluating prevalence, the article analyzes the victim's and perpetrator's characteristics, identifies the main strategies used in coercion, and explores the social scenarios that favor the occurrence of sexual violence. The article draws on data from a household survey called the GRAVAD Project, conducted in Porto Alegre, Rio de Janeiro, and Salvador and completed in 2002. Interviews were applied to a stratified sample of males and females aged 18-24 years, with 4,634 respondents (47.2% males and 52.8% females). Prevalence of some lifetime experience as victims of sexual coercion was estimated at 16.5% for women and 11.1% for men. Victim's and perpetrator's age in the first episode, the type of relationship between them, and the forms of pressure varied between males and females. The magnitude of such events, differences between men and women, and the higher prevalence rates in certain population sub-groups demand immediate preventive policies and strategies.

[Negotiation and conflict: gender and sexual coercion in three Brazilian capitals]. / Entre negociação e conflito: gênero e coerção sexual em três capitais Brasileiras.

This article discusses sexual coercion based on a population survey data, collected between 2001 and 2002, in three Brazilian capitals (Rio de Janeiro, Salvador e Porto Alegre)--Gravad Research. The results presented refer to questions about aspects of sexual negotiation, taken as possible experiences to be identified as sexual coercion, as well as youth values and opinions concerned to sexuality. The interviews were applied to males and females aged 18-24. Analysis of the empirical data points to the importance of specific scripts and to local dynamics and beliefs in the sexual interaction between genders in terms of identifying some behaviors as ways of forced sex. We aim to relativize the notion of violence that is much present in great part of the international literature about this theme.