Trastornos mentales y conflicto armado interno en Guatemala / Mental disorders and the internal armed conflict in Guatemala

Introducción. La sociedad guatemalteca estuvo expuesta a un conflicto armado interno durante el período de 1962 a 1996. Durante esos años la sociedad civil estuvo sometida a múltiples eventos traumáticos. El objetivo de este estudio es conocer el impacto psicológico que tuvo el conflicto sobre la salud mental de los guatemaltecos. Métodos. Una revisión de artículos publicados entre 1962 y 2004 en las bases de datos Medline, Lilacs, Embase, Psiclit-Infon, Cochrane Library y Pilots. Se seleccionaron los artículos que originaron prevalencias de trastornos mentales en guatemaltecos a través de instrumentos estandarizados. Resultados. Fueron encontrados ocho estudios epidemiológicos que demuestran, en general, elevadas prevalencias de trastornos mentales en diferentes grupos de poblaciones afectadas por la violencia. Para la depresión, rangos entre 38,8 y 41,8 %; para los cuadros de ansiedad, intervalos entre 27,7 y 54,4 %; para problemas del sueño, 75 %, y para el trastorno de estrés postraumático (TEPT), estudios con frecuencias bajas entre un 2 y un 11,8 %, y otros estudios que demuestran prevalencias mayores, entre un 32 y un 52 %. Conclusiones. Estas prevalencias de trastornos mentales pueden ser interpretadas como elevadas cuando se comparan con estudios poblacionales de personas no expuestas a conflictos armados y en donde los rangos de TEPT van de manera general entre 0,5 y 11,7 %, permitiendo inferir que estas frecuencias altas están probablemente relacionadas a las experiencias traumáticas de la guerra en Guatemala y del exilio

Introduction. The Guatemalan society was exposed to an internal armed conflict during the period from 1962 to 1996. During these years, the civil society suffered multiple traumatic events. The objective of this study is to understand the psychological impact that the conflict had on the mental health of the Guatemalans. Methods. A review of articles published between 1962 and 2004, in the databases Medline, Lilacs, Embase, Psiclit- Infon, Cochrane Library and Pilots was conducted. The articles that were selected found mental disorder prevalences in Guatemalans through standardized instruments. Results. Eight studies were found to demonstrate, in general, elevated prevalences for mental disorders in different population groups affected by the violence. For the depression ranges, the prevalence was between 38.8% and 41.8%; for anxiety symptoms intervals between 27.7% and 54.4 %; for sleep problems, 75 %, and for posttraumatic stress disorder (PTSD) studies with low frequencies from 2% to 11.8 % and other studies that demonstrated higher prevalences from 32% to 52%. Conclusions. These mental disorders prevalences can be interpreted as elevated when compared with population studies of persons not exposed to armed conflicts where the PTSD ranges generally go from 0.5% to 11.7%. This permits the inference that these high frequencies are probably related to traumatic experiences of the war in Guatemala and in exile

Gender and minor psychiatric morbidity: results of a case-control study in a developing country.

OBJECTIVE: Women suffer from minor psychiatric disorders (MPM) more frequently than men. Most of the studies were conducted in England and in the United States and some reported the higher occurrence of MPM among women to be modified by marital status and others by sociodemographic variables. The present study intends to address this question in a developing country. METHOD: A population based case-control study was conducted in three important urban centers in Brazil. Two hundred seventy-six individuals diagnosed as new cases of MPM and 261 controls were selected to investigate the role of a set of sociodemographic variables in the association between gender and MPM using logistic regression models. RESULTS: Univariate analysis showed that women were more likely than men to suffer from MPM (OR = 3.34; 2.27-4.91). After controlling for other sociodemographic variables, female gender was still positively associated with MPM, but not in a homogeneous way. A multiplicative interaction of gender with age group was found (LRT = 6.01; 2 df; p = 0.05) suggesting an increment in the magnitude of the association among those older than thirty years. Odds-ratios were 2.33 (1.19-4.55), 6.85 (2.86-16.41), and 7.47 (2.90-19.22) for age groups of fourteen to twenty-nine; thirty to forty-four; forty-five or more, respectively. There was no evidence of interaction of gender with marital status or other sociodemographic variables. CONCLUSIONS: The findings are consistent with the modification of the association between gender and MPM being mediated by social factors.

Violent death in young people in the city of São Paulo, 1991-1993.

This paper aims to describe the principal causes of violent deaths among young people in the city of São Paulo, Brazil. Data from routine mortality statistics were used in the analysis. Young males were found to have a dramatically increased risk of death from violent causes especially those resident in lower income areas of the city. Possible explanations for these findings include economic instability generating social and cultural inequalities.

Brazilian multicentric study of psychiatric morbidity. Methodological features and prevalence estimates.

BACKGROUND: Psychiatric morbidity studies in developing countries have used diagnostic procedures of low reliability, without a clinical definition of caseness, producing descriptive data with limited application for mental health planning. METHOD: A two-stage cross-sectional design (with a sample size of 6476) was conducted to estimate the prevalence of DSM-III psychiatric diagnoses in three metropolitan areas of Brazil (Brasília, São Paulo and Porto Alegre). All subjects were screened for the presence of psychopathology with a 44-item instrument (the QMPA) and a subsample was selected for a psychiatric interview. RESULTS: Age-adjusted prevalence of cases potentially in need of care ranged from 19% (São Paulo) to 34% (Brasília and Porto Alegre). Anxiety disorders comprised the highest prevalences (up to 18%). Alcoholism yielded the most consistent prevalence levels, around 8% in all sites. Depression showed great variation between areas: from less than 3% (São Paulo and Brasília) to 10% (Porto Alegre). CONCLUSIONS: Overall prevalences were high in comparison with previous studies conducted in Brazil. A female excess of non-psychotic disorders (anxiety, phobias, somatisation and depression) and a male excess for alcoholism were consistently found.

Minor psychiatric morbidity and internal migration in Brazil.

Studies of non-psychotic disorders in migrants have shown inconsistent results. This paper reports the findings of a case-control study carried out in three cities in Brazil to investigate the association between migration and minor psychiatric morbidity (MPM). Two hundred and seventy-six cases and 261 controls were selected from a survey of 6740 people aged 15 years or more. Diagnoses were made using the DSM-III Symptom Checklist. A statistically significant increase in risk of MPM in migrants was found by univariate analysis [odds ratio (OR) = 1.76; 95% confidence interval (CI) = 1.21-2.57. After controlling for gender, age, educational level, marital status, place of residence and position in the labour market, the overall increase in risk of MPM disappeared (OR = 1.02; 95% CI = 0.64-1.64), but a statistically significant increase in risk was present only in migrant unemployed women. This finding did not support models that explain risk in migrants by viewing migration as associated with cultural change and stressful life events. On the other hand, models based on the concept of selection- displacement from the labour market are more consistent with the present findings.

Mental health of the mothers of malnourished children.

BACKGROUND: The objective of this study is to measure the association between protein-energy malnutrition (PEM) in children and their mothers' mental health, in a low income area in the city of Embú, São Paulo, Brazil. METHODS: A case-control study was performed. Cases were 60 moderately and severely malnourished children (Gomez criteria) selected from two primary health care units. Controls consisted of 45 eutrophic children attending the same units. The main outcome measure was for the mothers to present a mental health score > 6 according with the 'Adult Psychiatric Morbidity Questionnaire' (QMPA), a psychiatric screening instrument. RESULTS: Of mothers of children with PEM, 63% and 38% of mothers in the control group were QMPA positive: odds ratio (OR) = 2.8 (95% confidence interval [CI]: 1.2-6.9). Of PEM children, 27% had low birthweight (LBW = < 2500 g) and 6% of the control group had LBW. Interactions were found between: mothers' mental health and number of children (with > or = 4 children: OR = 20.0 [95% CI: 2.1-274.2], with < or = 3 children: OR = 1.6 [95% CI: 0.6-4.5), as well as mothers' mental health and maternal age (in women > 30: OR = 12.5 [95% CI: 2.0-93.4], in women < or = 30: OR = 1.5 [95% CI: 0.5-4.4]. CONCLUSIONS: Mothers of children with PEM showed a higher rate of mental disturbances than mothers of eutrophic children. Unlike LBW, maternal age and number of children interact with mothers' mental health, increasing the association. Management of poor mental health may lead to mothers being better caretakers of their children and this may have a positive impact on PEM.

The use of the face-hand test to screen for organic brain syndromes. A pilot study.

A reduced version of the Face-Hand Test (FHT), the FHT-R, was applied to a random sample of 91 elderly subjects living in the community (S. Paulo-Brazil), to study the instrument's ability to detect Organic Brain Syndrome (OBS). The scores of the FHT-R test were then compared with a psychiatric assessment using the Clinical Interview Schedule. Five persons were regarded as OBS "cases" and 86 as OBS "non cases". At the cut-off point 0/1 the validity coefficients were as follows: Sensitivity 60%, Specificity 94%, Positive Predictive Value 38%, Negative Predictive Value 98% and Overall Misclassification Rate 8%. The usefulness of this clinical test to screen for OBS in epidemiological surveys is discussed.

Validity of a Brazilian version of the Older Americans Resources and Services (OARS) mental health screening questionnaire.

A validity study of the Brazilian version of the 15-item Short Psychiatric Evaluation Schedule (SPES), included in the mental health assessment of Older Americans Resources and Services (OARS), designed to detect psychiatric disorders in the elderly, against the "caseness" criterion suggested by Cooper and Schwarz was carried out with a community sample, as part of a survey to study health and living conditions of the elderly in a large urban center of a developing country, São Paulo, Brazil. The screening questionnaire was completed by 292 subjects, and 91 were selected for the psychiatric interview. The validity coefficients were as follows: sensitivity 61%, specificity 89%, positive predictive value 66%, negative predictive value 87% and misclassification rate 18%. A discriminant analysis using a stepwise procedure was then applied to select the best item discriminators of the screening questionnaire. The best set of discrimination comprised six items leading to the following validity coefficients: sensitivity 82%, specificity 77%, positive predictive value 58%, negative predictive value 92% and misclassification rate 21%. The possible factors related to false positive and false negative responses on the screening are discussed.