Gender-related dimensions of childhood adversities in the general population

Objective: Childhood adversities (CAs) comprise a group of negative experiences individuals may suffer in their lifetimes. The goal of the present study was to investigate the cluster discrimination of CAs through psychometric determination of the common attributes of such experiences for men and women. Methods: Parental mental illness, substance misuse, criminality, death, divorce, other parental loss, family violence, physical abuse, sexual abuse, neglect, physical illness, and economic adversity were assessed in a general-population sample (n=5,037). Exploratory and confirmatory factor analysis determined gender-related dimensions of CA. The contribution of each individual adversity was explored through Rasch analysis. Results: Adversities were reported by 53.6% of the sample. A three-factor model of CA dimensions fit the data better for men, and a two-factor model for women. For both genders, the dimension of family maladjustment - encompassing physical abuse, neglect, parental mental disorders, and family violence - was the core cluster of CAs. Women endorsed more CAs than men. Rasch analysis found that sexual abuse, physical illness, parental criminal behavior, parental divorce, and economic adversity were difficult to report in face-to-face interviews. Conclusion: CAs embrace sensitive personal information, clustering of which differed by gender. Acknowledging CAs may have an impact on medical and psychiatric outcomes in adulthood.

Family burden related to mental and physical disorders in the world: results from the WHO World Mental Health (WMH) surveys

Objective: To assess prevalence and correlates of family caregiver burdens associated with mental and physical conditions worldwide. Methods: Cross-sectional community surveys asked 43,732 adults residing in 19 countries of the WHO World Mental Health (WMH) Surveys about chronic physical and mental health conditions of first-degree relatives and associated objective (time, financial) and subjective (distress, embarrassment) burdens. Magnitudes and associations of burden are examined by kinship status and family health problem; population-level estimates are provided. Results: Among the 18.9-40.3% of respondents in high, upper-middle, and low/lower-middle income countries with first-degree relatives having serious health problems, 39.0-39.6% reported burden. Among those, 22.9-31.1% devoted time, 10.6-18.8% had financial burden, 23.3-27.1% reported psychological distress, and 6.0-17.2% embarrassment. Mean caregiving hours/week was 12.9-16.5 (83.7-147.9 hours/week/100 people aged 18+). Mean financial burden was 15.1% of median family income in high, 32.2% in upper-middle, and 44.1% in low/lower-middle income countries. A higher burden was reported by women than men, and for care of parents, spouses, and children than siblings. Conclusions: The uncompensated labor of family caregivers is associated with substantial objective and subjective burden worldwide. Given the growing public health importance of the family caregiving system, it is vital to develop effective interventions that support family caregivers. .

O processo diagnóstico nos transtornos ansiosos / The diagnostic process in anxiety disorders

A eficácia de entrevistas rápidas na correta avaliação de pacientes com transtornos de ansiedade foi avaliada em 95 atendimentos iniciais feitos por um grupo especializado no tratamento de transtornos ansiosos. As impressões diagnósticas assim obtidas foram comparadas com entrevistas longas e cuidadosas realizadas até 30 dias após a avaliação inicial. Transtorno de pânico com ou sem agorafobia foi o diagnóstico mais frequente, realizado de forma segura em 53 pacientes já na primeira entrevista. A entrevista breve, no entanto, mostrou-se ineficaz na identificação correta de sintomas depressivos, que apareceram com grande frequência na segunda consulta, sugerindo que, mesmo que o diagnóstico de transtorno ansioso pareça claro num primeiro contato rápido com o paciente, sintomas depressivos sejam especificamente explorados, mesmo que isto demande maior tempo de entrevista

PSE: traduçäo, treinamento e limitaçöes ao seu uso no Brasil / PSE: tradution, training and limitations to its use in Brazil

É feito um breve histórico do sistema PSE. A seguir säo apontados os principais problemas encontrados na traduçäo da entrevista, seu glossário e lista de síndromes para o português. Essa traduçäo, iniciada em 1974, somente foi publicada em 1983 devido a falta de suporte financeiro e falta de perspectivas de utilizaçäo imediata em nosso meio. Foram encontradas dificuldades específicas para traduçäo de alguns termos alemäes e ingleses sem correspondente em nossa língua e para a adaptaçäo das perguntas ao nível sócio-cultural da maioria de nossos pacientes. A traduçäo näo foi vertida e comparada com os originais ingleses, mas aparentemente näo existem maiores problemas quanto à sua fidedignidade. Säo propostos passos para o treinamento de pessoal compatíveis com nossa realidade e que incluem: familiarizaçäo com a entrevista, observaçäo de entrevistas gravadas e ao vivo, e testes de confiabilidade com supervisores previamente treinados. As principais limitaçöes para o uso do sistema PSE no Brasil säo a falta de centros de treinamento com alta confiabilidade e de um centro de computaçäo e estatística capaz de analisar os resultados através do CATEGO e outros programas. É sugerida a criaçäo de um centro de referência de diagnóstico da OMS para língua portuguesa no Brasil