Community violence in neighborhoods and common mental disorders among Brazilian adolescents.

BACKGROUND: This study aims to explore the association between exposure to neighborhood violence and the presence of common mental disorders (CMDs) among Brazilian adolescents aged 12 to 17 years. Additionally, we aim to analyze whether sex, age and race are modifiers of the effect of this association. METHODS: The study comprised 1,686 adolescents residing in the municipality of Rio de Janeiro, situated in the Southeast region of Brazil. To measure exposure to community violence, we constructed three crime indicators using data from Civil Police of the State of Rio de Janeiro: crimes against property, nonlethal crimes, and lethal crimes. Employing geospatial analysis based on the adolescents' residence location, logistic regression modeling was performed to measure the association between violence and CMDs. RESULTS: Adolescents living in regions with higher rates of the three types of violence studied herein were more likely to have CMDs, with odds ratios (ORs) ranging from 2.33 to 2.99. When stratified by sex, age and race, girls, older adolescents and blacks have a greater magnitude of effect on the measure of association, indicating a heightened risk for CMDs. CONCLUSION: This study provides important contributions to the public health field, as it reveals new information on the influence of community violence on the mental health of adolescents. Given the elevated rates of violence globally, knowing the effects of such violence on adolescents becomes crucial for the prevention and treatment of CMDs within this population.

International perspective on integrated care models in child and adult mental health.

The dearth of child and adolescent mental health services (CAMHS) is a global problem. Integrating CAMHS in primary care has been offered as a solution. We sampled integrated care perspectives from colleagues around the world. Our findings include various models of integrated care namely: the stepped care model in Australia; shared care in the United Kingdom (UK) and Spain; school-based collaborative care in Qatar, Singapore and the state of Texas in the US; collaborative care in Canada, Brazil, US, and Uruguay; coordinated care in the US; and, developing collaborative care models in low-resource settings, like Kenya and Micronesia. These findings provide insights into training initiatives necessary to build CAMHS workforce capacity using integrated care models, each with the ultimate goal of improving access to care. Despite variations and progress in implementing integrated care models internationally, common challenges exist: funding within complex healthcare systems, limited training mechanisms, and geopolitical/policy issues. Supportive healthcare policy, robust training initiatives, ongoing quality improvement and measurement of outcomes across programs would provide data-driven support for the expansion of integrated care and ensure its sustainability.

Community violence and internalizing mental health symptoms in adolescents: A systematic review.

PURPOSES: Mental disorders are responsible for 16% of the global burden of disease in adolescents. This review focuses on one contextual factor called community violence that can contribute to the development of mental disorders OBJECTIVE: To evaluate the impact of community violence on internalizing mental health symptoms in adolescents, to investigate whether different proximity to community violence (witness or victim) is associated with different risks and to identify whether gender, age, and race moderate this association. METHODS: systematic review of observational studies. The population includes adolescents (10-24 years), exposition involves individuals exposed to community violence and outcomes consist of internalizing mental health symptoms. Selection, extraction and quality assessment were performed independently by two researchers. RESULTS: A total of 2987 works were identified; after selection and extraction, 42 works remained. Higher exposure to community violence was positively associated with internalizing mental health symptoms. Being a witnessing is less harmful for mental health than being a victim. Age and race did not appear in the results as modifiers, but male gender and family support appear to be protective factors in some studies. CONCLUSION: This review confirms the positive relationship between community violence and internalizing mental health symptoms in adolescents and provides relevant information that can direct public efforts to build policies in the prevention of both problems.

Violência comunitária e saúde mental de adolescentes / Community violence and mental health symptoms

Esta tese avalia a associação entre violência comunitária (VC) e transtornos mentais internalizantes (TMI) em adolescentes e jovens. Os dois primeiros manuscritos se referem a uma revisão sistemática cujo objetivo foi investigar se: (i) a maior exposição à VC está associada a maior risco de TMI, (ii) diferentes graus de vitimização estão associados de forma distinta a sintomas de depressão, ansiedade e transtorno do estresse pós-traumático (TEPT), e (iii) gênero, idade e cor da pele/raça influenciam nesta relação. As etapas de seleção, extração e avaliação da qualidade foram realizadas por duplas de pesquisadoras e de acordo com o Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P). A busca resultou em 2987 trabalhos, após a aplicação dos critérios de seleção, foram incluídos na revisão 42 estudos. Os resultados demonstraram que há uma associação entre VC e TMI, que as vítimas têm maior risco do que as testemunhas para o desenvolvimento de depressão, ansiedade e TEPT e que as meninas estão mais vulneráveis quando expostas ao mesmo nível de VC, quando comparadas aos meninos. Idade e cor da pele/raça não apareceram como modificadores de efeito, porém foram escassos os estudos que testaram esses fatores. O terceiro manuscrito apresenta os resultados de uma pesquisa transversal realizada com adolescentes participantes do Estudo de Riscos Cardiovasculares em Adolescentes (ERICA) cujo objetivo foi avaliar a associação entre diferentes tipos de crimes com a presença de transtornos mentais comuns (TMC) em adolescentes residentes na cidade do Rio de Janeiro. Foram construídos indicadores de criminalidade a partir de registros de boletins de ocorrência da Polícia Civil do Rio de Janeiro, dividindo-os em crimes contra o patrimônio e crimes contra a vida letais e não letais. Os dados foram submetidos a análise geoespacial e testados em modelos de regressão logística. Os resultados demonstraram que os Odds Ratios (OR) para ocorrência de TMC foram maiores entre adolescentes que vivem em regiões mais violentas quando considerados os três tipos de crimes, sendo os ORs e respectivos intervalos de confiança de 95%: 2,97 (1,97-4,50) para crimes contra o patrimônio, 2,46 (1,54-3,93) para crimes não letais, e 2,35 (1,65-3,34) para crimes letais. Os ORs foram maiores entre meninas, em comparação a meninos, adolescentes mais velhos em relação aos mais novos e em negros quando comparados aos não negros, também para os três tipos de crimes. Esta tese contribui para o avanço no conhecimento científico na área da violência e saúde mental de adolescentes, ambos os fenômenos passíveis de intervenção preventiva. Traz como inovação a atualização sistemática do conhecimento no campo e o apontamento de que meninas, adolescentes mais novos e negros estão mais vulneráveis que seus pares quando expostos à VC.

This thesis assesses the association between community violence (CV) and internalizing mental disorders (IMD) in adolescents and youngs. The first two manuscripts refer to a systematic review which objective was to investigate if: (i) higher exposure to VC is associated with greater risk of TMI, (ii) different degrees of proximity with VC are distinctly associated with symptoms of depression, anxiety and post-traumatic stress disorder (PTSD), (iii) gender, age and race influence this relationship. The stages of selection, extraction and quality assessment were carried out by pair of researchers and according to the Preferred Reporting Items for Systematic Reviews and meta-Analysis Protocols (PRISMA-P). The search resulted in 2987 works, after applying the selection criteria, 42 studies were included in the review. The results showed that there is an association between CV and IMD, that victims are at greater risk than witnesses for the development of depression, anxiety and PTSD and that girls are more vulnerable when exposed to the same level of VC when compared to boys. Age and race did not appear as effect modifiers, but studies that tested these factors were scarse. The third manuscript present the results of a cross-sectional survey conducted with individuals that participated in the Study of Cardiovascular Risk in Adolescents (ERICA) which objective was to assess the association between different types of crimes with the presence of common mental disorders (CMD) in adolescents living in the city of Rio de Janeiro. Crime indicators were constructed based on records of police reports from the Civil Police of Rio de Janeiro, dividing them into crimes against property and crimes against life, lethal and non-lethal. The data were submitted to geospatial analysis and tested in logistic regression models. The results showed that the OR for the occurrence of CMD were higher among adolescents living in more violent regions when considering the three types of crimes, the ORs and respective 95% confidence intervals being: 2,97 (1,97 ­ 4,50) for crimes against property; 2,46 (1,54 ­ 3,93) for non-lethal crimes; and 2,35 (1,65 ­ 3,34) for lethal crimes. The ORs were higher among girls compared to boys, older adolescents compared to younger ones, and in black compared to non-blacks, also for the three types of crimes. This thesis contributes to the advancement of scientific knowledge in the area of violence and mental health of adolescents, both phenomena subject to preventive intervention. It brings as innovation the systematic updating of knowledge in the field and the observation that girls, younger adolescents and blacks are more vulnerable than their peers when exposed to CV.

Association between psychiatric hospitalizations, coverage of psychosocial care centers (CAPS) and primary health care (PHC) in metropolitan regions of Rio de Janeiro (RJ) and São Paulo (SP), Brazil. / Associação entre Internações psiquiátricas, cobertura de CAPS e atenção básica em regiões metropolitanas do RJ e SP, Brasil.

To analyze the association between the coverage of psychosocial care centers (CAPS) and Primary Health Care (PHC) and the number of psychiatric hospitalizations in the metropolitan regions of the capitals of Rio de Janeiro (RJ) and São Paulo (SP) states. This is an ecological time-series study with population consisting of dwellers of metropolitan areas of the municipalities of RJ and SP hospitalized in the Unified Health System (SUS). Secondary data were collected from DATASUS and IBGE portal and indicators calculated (CAPS supply, PHC coverage, provision of psychiatric beds and psychiatric hospitalization rates). Indicators' time trends and the association between CAPS and PHC coverage and hospitalization rates were calculated. Reduced psychiatric hospitalizations rates and psychiatric beds and increased CAPS and PHC coverage were observed in the two location under study, with inverse and statistically significant association. Results confirmed the hypothesis of association between increasing CAPS and PHC supply with decreased psychiatric hospitalization rates, in the study's period and regions. This finding reinforces the importance of continuous and improved health and psychiatric reform-related policies.

CONCLUSÕES: O objetivo deste artigo é analisar a associação entre a cobertura de Centros de Atenção Psicossocial (CAPS) e a Atenção Básica (AB) e o número de internações psiquiátricas, nas regiões metropolitanas das capitais dos Estados de Rio de Janeiro (RJ) e São Paulo (SP). Estudo ecológico de séries temporais com população composta por residentes das regiões metropolitanas dos municípios do RJ e de SP internados no âmbito do SUS. Dados secundários foram coletados (portal do DATASUS e IBGE) e calculados indicadores (oferta de CAPS, cobertura da AB, oferta de leitos psiquiátricos e taxa de internações psiquiátricas). Foram calculadas as tendências temporais dos indicadores e a associação entre as coberturas de CAPS e AB e as taxas de internação. Observou-se redução das taxas de internações psiquiátricas e oferta de leitos e aumento da cobertura de CAPS e AB nas duas localidades estudadas, com associação inversa e estatisticamente significativa. : os resultados confirmaram a hipótese de associação entre as tendências crescentes de oferta de CAPS e AB e diminuição das taxas de internação psiquiátrica no período e regiões do estudo. Este achado reforça a importância da continuidade e aprimoramento das políticas relacionadas às reformas psiquiátrica e sanitária.

Associação entre Internações psiquiátricas, cobertura de CAPS e atenção básica em regiões metropolitanas do RJ e SP, Brasil / Association between psychiatric hospitalizations, coverage of psychosocial care centers (CAPS) and primary health care (PHC) in metropolitan regions of Rio de Janeiro (RJ) and São Paulo (SP), Brazil

Resumo Conclusões O objetivo deste artigo é analisar a associação entre a cobertura de Centros de Atenção Psicossocial (CAPS) e a Atenção Básica (AB) e o número de internações psiquiátricas, nas regiões metropolitanas das capitais dos Estados de Rio de Janeiro (RJ) e São Paulo (SP). Estudo ecológico de séries temporais com população composta por residentes das regiões metropolitanas dos municípios do RJ e de SP internados no âmbito do SUS. Dados secundários foram coletados (portal do DATASUS e IBGE) e calculados indicadores (oferta de CAPS, cobertura da AB, oferta de leitos psiquiátricos e taxa de internações psiquiátricas). Foram calculadas as tendências temporais dos indicadores e a associação entre as coberturas de CAPS e AB e as taxas de internação. Observou-se redução das taxas de internações psiquiátricas e oferta de leitos e aumento da cobertura de CAPS e AB nas duas localidades estudadas, com associação inversa e estatisticamente significativa. : os resultados confirmaram a hipótese de associação entre as tendências crescentes de oferta de CAPS e AB e diminuição das taxas de internação psiquiátrica no período e regiões do estudo. Este achado reforça a importância da continuidade e aprimoramento das políticas relacionadas às reformas psiquiátrica e sanitária.

Abstract To analyze the association between the coverage of psychosocial care centers (CAPS) and Primary Health Care (PHC) and the number of psychiatric hospitalizations in the metropolitan regions of the capitals of Rio de Janeiro (RJ) and São Paulo (SP) states. This is an ecological time-series study with population consisting of dwellers of metropolitan areas of the municipalities of RJ and SP hospitalized in the Unified Health System (SUS). Secondary data were collected from DATASUS and IBGE portal and indicators calculated (CAPS supply, PHC coverage, provision of psychiatric beds and psychiatric hospitalization rates). Indicators' time trends and the association between CAPS and PHC coverage and hospitalization rates were calculated. Reduced psychiatric hospitalizations rates and psychiatric beds and increased CAPS and PHC coverage were observed in the two location under study, with inverse and statistically significant association. Results confirmed the hypothesis of association between increasing CAPS and PHC supply with decreased psychiatric hospitalization rates, in the study's period and regions. This finding reinforces the importance of continuous and improved health and psychiatric reform-related policies.