Local understandings of PTSD and complex PTSD among health professionals working with adolescents in violent neighbourhoods of São Paulo city, Brazil.

BACKGROUND: Adolescents in low-resource urban settings in Brazil are often exposed to high levels of trauma that can result in post-traumatic stress disorder (PTSD). However, preliminary evidence indicates that PTSD tends to be under-reported in Brazilian health services, despite the high prevalence of trauma. Additionally, little is known about the perceived applicability among clinicians of the new ICD-11 diagnosis of complex PTSD (CPTSD), despite its potential relevance for contexts of chronic trauma. The current study investigated local understandings of PTSD and CPTSD among health professionals working with adolescents in violent neighbourhoods of São Paulo city. METHODS: Semi-structured interviews were conducted with 58 health professionals working at both the primary care and specialized mental health levels in two areas of São Paulo city with high levels of community violence. RESULTS: Most participants knew about PTSD, but most did not know about CPTSD. There were mixed views concerning the commonality of PTSD among adolescents exposed to community violence. Many participants reported having no experience working with patients with the PTSD diagnosis. According to some, community violence was normalized by adolescents and health professionals, and did not result in PTSD. Others highlighted how they did not use psychiatric diagnoses in their practice, had critical perspectives towards psychiatric diagnoses and/or PTSD, or simply knew little about PTSD. Furthermore, many highlighted how the chronic nature of multiple traumas experienced by adolescents often resulted in complex clinical presentations characterised by many symptoms beyond PTSD. The diagnosis of CPTSD was considered appropriate to the context by many participants as it captured the complex traumatic histories and symptom presentations of adolescents exposed to community violence in Brazil. CONCLUSIONS: These findings have important implications for the assessment and treatment of mental health among adolescents exposed to community violence in Brazil.

[Homicide and public security indicator trends in the city of São Paulo between 1996 and 2008: a time-series ecological study]. / Evolução dos homicídios e indicadores de segurança pública no Município de São Paulo entre 1996 a 2008: um estudo ecológico de séries temporais.

The scope of this paper was to analyze the association between homicides and public security indicators in São Paulo between 1996 and 2008, after monitoring the unemployment rate and the proportion of youths in the population. A time-series ecological study for 1996 and 2008 was conducted with São Paulo as the unit of analysis. Dependent variable: number of deaths by homicide per year. Main independent variables: arrest-incarceration rate, access to firearms, police activity. Data analysis was conducted using Stata.IC 10.0 software. Simple and multivariate negative binomial regression models were created. Deaths by homicide and arrest-incarceration, as well as police activity were significantly associated in simple regression analysis. Access to firearms was not significantly associated to the reduction in the number of deaths by homicide (p>0,05). After adjustment, the associations with both the public security indicators were not significant. In São Paulo the role of public security indicators are less important as explanatory factors for a reduction in homicide rates, after adjustment for unemployment rate and a reduction in the proportion of youths. The results reinforce the importance of socioeconomic and demographic factors for a change in the public security scenario in São Paulo .

Fall in homicides in the city of São Paulo: an exploratory analysis of possible determinants.

Throughout the first decade of the 2000s the homicide mortality rate (HMR) showed a significant reduction in the state and the city of São Paulo (MSP). The aim of this study is to describe the trend of HMR, socio-demographic indicators, and the investment in social and public security, and to analyze the correlation between HMR and independent variables in the MSP between 1996 and 2008. An exploratory time series ecological study was conducted. The following variables were included: HMR per 100,000 inhabitants, socio-demographic indicators, and investments in social and public security. The moving-averages for all variables were calculated and trends were analyzed through Simple Linear Regression models. Annual percentage changes, the average annual change and periodic percentage changes were calculated for all variables, and the associations between annual percentage changes were tested by Spearman's correlation analysis. Correlations were found for the proportion of youth in the population (r = 0.69), unemployment rate (r = 0.60), State budget for education and culture (r = 0.87) and health and sanitation (r = 0.56), municipal (r = 0.68) and State (r = 0.53) budget for Public Security, firearms seized (r = 0.69) and the incarceration rate (r = 0.71). The results allow us to support the hypothesis that demographic changes, acceleration of the economy, in particular the fall in unemployment, investment in social policies and changes in public security policies act synergistically to reduce HMR in São Paulo. Complex models of analysis, incorporating the joint action of different potential explanatory variables, should be developed.