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Mental Disorders in Megacities: Findings from the Sao Paulo Megacity Mental Health Survey, Brazil

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Andrade, Laura Helena [1] ; Wang, Yuan-Pang [1] ; Andreoni, Solange [2] ; Silveira, Camila Magalhaes [1] ; Alexandrino-Silva, Clovis [1] ; Siu, Erica Rosanna [1] ; Nishimura, Raphael [3] ; Anthony, James C. [4] ; Gattaz, Wagner Farid [5] ; Kessler, Ronald C. [6] ; Viana, Maria Carmen [1]
Número total de Autores: 11
Afiliação do(s) autor(es):
[1] Univ Sao Paulo, Sch Med, Dept & Inst Psychiat, Sect Psychiat Epidemiol LIM 23, Sao Paulo - Brazil
[2] Univ Fed Sao Paulo, Dept Prevent Med, Sao Paulo - Brazil
[3] Univ Michigan, Inst Social Res, Ann Arbor, MI - USA
[4] Michigan State Univ, Coll Human Med, Dept Epidemiol, E Lansing, MI 48824 - USA
[5] Univ Sao Paulo, Sch Med, Dept & Inst Psychiat, Lab Neurosci LIM 27, Sao Paulo - Brazil
[6] Harvard Univ, Sch Med, Dept Hlth Care Policy, Boston, MA 02115 - USA
Número total de Afiliações: 6
Tipo de documento: Artigo Científico
Fonte: PLoS One; v. 7, n. 2 FEB 14 2012.
Citações Web of Science: 127

Background: World population growth is projected to be concentrated in megacities, with increases in social inequality and urbanization-associated stress. Sao Paulo Metropolitan Area (SPMA) provides a forewarning of the burden of mental disorders in urban settings in developing world. The aim of this study is to estimate prevalence, severity, and treatment of recently active DSM-IV mental disorders. We examined socio-demographic correlates, aspects of urban living such as internal migration, exposure to violence, and neighborhood-level social deprivation with 12-month mental disorders. Methods and Results: A representative cross-sectional household sample of 5,037 adults was interviewed face-to-face using the WHO Composite International Diagnostic Interview (CIDI), to generate diagnoses of DSM-IV mental disorders within 12 months of interview, disorder severity, and treatment. Administrative data on neighborhood social deprivation were gathered. Multiple logistic regression was used to evaluate individual and contextual correlates of disorders, severity, and treatment. Around thirty percent of respondents reported a 12-month disorder, with an even distribution across severity levels. Anxiety disorders were the most common disorders (affecting 19.9%), followed by mood (11%), impulse-control (4.3%), and substance use (3.6%) disorders. Exposure to crime was associated with all four types of disorder. Migrants had low prevalence of all four types compared to stable residents. High urbanicity was associated with impulse-control disorders and high social deprivation with substance use disorders. Vulnerable subgroups were observed: women and migrant men living in most deprived areas. Only one-third of serious cases had received treatment in the previous year. Discussion: Adults living in Sao Paulo megacity had prevalence of mental disorders at greater levels than similar surveys conducted in other areas of the world. Integration of mental health promotion and care into the rapidly expanding Brazilian primary health system should be strengthened. This strategy might become a model for poorly resourced and highly populated developing countries. (AU)

Processo FAPESP: 03/00204-3 - Estudo epidemiológico dos transtornos psiquiátricos na região metropolitana de São Paulo: prevalências, fatores de risco e sobrecarga social e econômica
Beneficiário:Laura Helena Silveira Guerra de Andrade Burdmann
Linha de fomento: Auxílio à Pesquisa - Temático