ABSTRACT
BACKGROUND: We estimate work loss and economic costs due to mental and substance use disorders in the economically active population of the São Paulo Metropolitan Area, Brazil. METHODS: The São Paulo Megacity Mental Health Survey assessed a population-based sample of 3,007 economically active residents using the Composite International Diagnostic Interview 3.0 and the World Health Organization Disability Assessment Schedule 2 to investigate, respectively, 12-month psychiatric disorders, work performance, and economic costs. RESULTS: Absenteeism over the past 12 months was reported by 12.6%, and presenteeism by 14.7% (qualitative loss) and 13.1% (quantitative loss). Having any mental disorder was associated with 17.6 days of absenteeism and 37.7 days of reduced-qualitative and/or quantitative functioning. Fourteen mental disorders were significantly associated with work loss, with odds ratios ranging from 2.3 for adult separation anxiety to 40.4 for oppositional defiant disorder. At a population-level, oppositional defiant disorder, panic disorder, attention deficit disorder, and dysthymia contributed to the largest costs. The total annual economic costs were USD $83.2 billion/year, representing 6.1% of Brazil's Gross Domestic Product in 2007. LIMITATIONS: Diagnosis of mental disorders was based on self-reported symptoms. Work loss assessment was restricted to 30 days before the interview and may not fully represents the annual real experience and symptoms of the respondents which would lead to an overestimation of the burden. CONCLUSIONS: Mental disorders impose a great negative impact on work performance and functioning, with a consequent high economic burden, pointing to the need of implementing cost-effective interventions to prevent work loss.
Subject(s)
Mental Disorders , Substance-Related Disorders , Absenteeism , Adult , Brazil/epidemiology , Humans , Mental Disorders/epidemiology , Presenteeism , Substance-Related Disorders/epidemiology , Surveys and QuestionnairesABSTRACT
OBJECTIVE: To translate, adapt and validate the contents of the Adverse Childhood Experiences International Questionnaire to a Portuguese version, to be used in Brazil, named Questionário Internacional de Experiências Adversas na Infância. METHODS: This is a methodological study of cross-cultural adaptation of evaluation instruments presenting the results of semantic equivalence between the original instrument and the adapted version. The semantic equivalence of the instrument involved the following steps: 1) two translations and a synthesis of the translations; 2) two retranslations; 3) validation of contents by eight health workers; 4) synthesis of the retranslations; 5) pre-tests to assess acceptability, understanding and emotional impact of the questions; and, finally, 6) writing of the final version of the instrument. RESULTS: the adapted version proved to be easy to apply and to understand and achieved good semantic equivalence when compared to the original version. The psychometric properties of the instrument still need to be evaluated. Limitations and recommendations for improving the instrument and its use are presented. CONCLUSION: The process of cross-cultural adaptation of the Adverse Childhood Experiences International Questionnaire resulted in an adapted version to Brazilian Portuguese.
Subject(s)
Adverse Childhood Experiences , Cross-Cultural Comparison , Brazil , Humans , Language , Reproducibility of Results , Surveys and Questionnaires , TranslationsABSTRACT
RESUMO O objetivo deste estudo foi identificar e descrever os instrumentos mais frequentemente utilizados nas pesquisas epidemiológicas para a avaliação das Experiências Adversas na Infância, nos últimos dez anos. Trata-se de uma revisão da literatura, cujos critérios de inclusão foram artigos disponíveis na íntegra, nos idiomas inglês, espanhol e português, publicados e indexados nas bases de dados Medline e Lilacs, que citassem no resumo os instrumentos de avaliação utilizados nos estudos. Foram analisados 6 dos 38 instrumentos identificados nos 253 artigos selecionados para análise. Os instrumentos mais citados foram: 1) Childhood Trauma Questionnaire, 2) Childhood Experience of Care and Abuse, 3) Adverse Childhood Experiences Questionnaire, 4) Child Abuse and Trauma Scale, 5) Early Trauma Inventory Self Report e 6) Adverse Childhood Experiences International Questionnaire. Os instrumentos descritos diferiram quanto às propriedades psicométricas, à idade para aplicação e à quantidade de Experiências Adversas na Infância avaliadas. Predominaram estudos publicados em periódicos internacionais na língua inglesa. Três instrumentos apresentam versão em português vigente no Brasil, sendo que um deles considera somente a avaliação de aspectos específicos de Experiências Adversas na Infância, enquanto que os outros dois avaliam, também, outras experiências traumáticas.
ABSTRACT This study aimed to identify and describe the most frequently used instruments in epidemiological research to assess Adverse Childhood Experiences, in the past ten years. This is an integrative literature review, whose inclusion criteria were: full text articles in English, Spanish and Portuguese, published and indexed in the Medline and Lilacs databases, which cited in the summary the assessment instruments used in the studies. Six of the 38 instruments identified in the 253 articles selected for analysis were analyzed. The most cited instruments were: 1) Childhood Trauma Questionnaire, 2) Childhood Experience of Care and Abuse, 3) Adverse Childhood Experiences Questionnaire, 4) Child Abuse and Trauma Scale, 5) Early Trauma Inventory Self Report and 6) Adverse Childhood Experiences International Questionnaire. The instruments described differed in terms of psychometric properties, age for application and number of Adverse Childhood Experiences assessed. Studies published in international journals in the English language predominated. Three instruments have a Brazilian Portuguese version, one of which only considers the assessment of specific aspects of Adverse Childhood Experiences, while the other two also evaluates other traumatic experiences.
ABSTRACT
ABSTRACT OBJECTIVE: To translate, adapt and validate the contents of the Adverse Childhood Experiences International Questionnaire to a Portuguese version, to be used in Brazil, named Questionário Internacional de Experiências Adversas na Infância. METHODS: This is a methodological study of cross-cultural adaptation of evaluation instruments presenting the results of semantic equivalence between the original instrument and the adapted version. The semantic equivalence of the instrument involved the following steps: 1) two translations and a synthesis of the translations; 2) two retranslations; 3) validation of contents by eight health workers; 4) synthesis of the retranslations; 5) pre-tests to assess acceptability, understanding and emotional impact of the questions; and, finally, 6) writing of the final version of the instrument. RESULTS: the adapted version proved to be easy to apply and to understand and achieved good semantic equivalence when compared to the original version. The psychometric properties of the instrument still need to be evaluated. Limitations and recommendations for improving the instrument and its use are presented. CONCLUSION: The process of cross-cultural adaptation of the Adverse Childhood Experiences International Questionnaire resulted in an adapted version to Brazilian Portuguese.
RESUMO OBJETIVO: Traduzir, adaptar e validar o conteúdo do Adverse Childhood Experiences International Questionnaire para uma versão em português, vigente no Brasil, nomeada como Questionário Internacional de Experiências Adversas na Infância. MÉTODOS: Trata-se de um estudo metodológico de adaptação transcultural de instrumentos de avaliação, em que são apresentados os resultados da equivalência semântica entre o instrumento original e a versão adaptada. A equivalência semântica do instrumento envolveu as seguintes etapas: 1) duas traduções e uma síntese das traduções; 2) duas retraduções; 3) validação de conteúdo realizado por oito profissionais da área da saúde; 4) síntese das retraduções; 5) pré-testes para avaliar a aceitabilidade, a compreensão e o impacto emocional das questões; e, por fim, 6) a elaboração da versão final do instrumento. RESULTADOS: A versão adaptada demonstrou ser de fácil aplicação e compreensão e obteve boa equivalência semântica quando comparada à original. As propriedades psicométricas do instrumento devem, ainda, ser avaliadas. Limitações e recomendações para a melhoria do instrumento e para a sua utilização são apresentadas. CONCLUSÃO: O processo de adaptação transcultural do Adverse Childhood Experiences International Questionnaire proporcionou uma versão adaptada para o português vigente no Brasil.
Subject(s)
Humans , Cross-Cultural Comparison , Adverse Childhood Experiences , Translations , Brazil , Surveys and Questionnaires , Reproducibility of Results , LanguageABSTRACT
OBJECTIVE: To identify the prevalence of 12-month self-reported pain and chronic pain in a general population and to describe their clinical profile to assess if chronic pain is associated with 12-month mental disorders. METHODS: The data used comes from the São Paulo Megacity Mental Health Survey, a population-based study assessing adult (≥ 18 years) residents of the São Paulo metropolitan area, Brazil. We have assessed the respondents (n = 5,037) using the Composite International Diagnostic Interview (CIDI 3.0), with a global response rate of 81.3%. Descriptive analyses have been performed, and crude and adjusted odds ratios (OR) have been calculated with logistic and multinomial regression and presented with respective 95% confidence intervals (95%CI). RESULTS: The prevalence of pain and chronic pain in the past 12 months were 52.6% (95%CI 50.3-54.8) and 31.0% (95%CI 29.2-32.7), respectively. Joints (16.5%, 95%CI 15.4-17.5) and back or neck (15.5%, 95%CI 14.2-16.9) were the most frequently reported anatomical sites of chronic pain. On a 10-point analogue scale, the mean intensity of the worst pain was 7.7 (95%CI 7.4-7.8), and the mean average pain was 5.5 (95%CI 5.2-5.6); the mean treatment response was 6.3 (95%CI 6.0-6.6). Mean pain duration was 16.1 (95%CI 15.6-17.0) days a month and 132 (95%CI 126-144) minutes a day. Chronic pain was associated with 12-month DSM-IV mental disorders (OR = 2.7, 95%CI 2.3-3.3), anxiety disorders (OR = 2.1, 95%CI 1.9-3.0), and mood disorders (OR = 3.3, 95%CI 2.4-4.1). CONCLUSIONS: A high prevalence of chronic pain in multiple sites is observed among the general adult population, and associations between chronic pain and mental disorders are frequent.
Subject(s)
Chronic Pain/epidemiology , Chronic Pain/psychology , Mental Disorders/epidemiology , Adolescent , Adult , Aged , Brazil/epidemiology , Comorbidity , Female , Humans , Male , Middle Aged , Prevalence , Self Report , Sex Factors , Socioeconomic Factors , Young AdultABSTRACT
Mental disorders are associated with employment status as significant predictors and as consequences of unemployment and early retirement. This study describes the estimates and associations of 12-month DSM-IV prevalence rates of mental disorders and use of health services with employment status by gender in the São Paulo Metropolitan Area, Brazil. Data from the São Paulo Megacity Mental Health Survey was analyzed (n = 5,037). This is a population-based study assessing the prevalence and determinants of mental disorders among adults, using the Composite International Diagnostic Interview. The associations were estimated by odds ratios obtained through binomial and multinomial logistic regression. This study demonstrates that having mental disorders, especially mood disorders, is associated with being inactive or unemployed among men and inactive among women, but only having a substance use disorder is associated with being unemployed among women. Among those with mental disorders, seeking health care services is less frequent within unemployed.
Subject(s)
Employment/statistics & numerical data , Mental Disorders/epidemiology , Adolescent , Adult , Aged , Brazil/epidemiology , Female , Health Services/statistics & numerical data , Health Surveys , Humans , Male , Middle Aged , Prevalence , Sex Factors , Urban Population , Young AdultABSTRACT
Abstract: Mental disorders are associated with employment status as significant predictors and as consequences of unemployment and early retirement. This study describes the estimates and associations of 12-month DSM-IV prevalence rates of mental disorders and use of health services with employment status by gender in the São Paulo Metropolitan Area, Brazil. Data from the São Paulo Megacity Mental Health Survey was analyzed (n = 5,037). This is a population-based study assessing the prevalence and determinants of mental disorders among adults, using the Composite International Diagnostic Interview. The associations were estimated by odds ratios obtained through binomial and multinomial logistic regression. This study demonstrates that having mental disorders, especially mood disorders, is associated with being inactive or unemployed among men and inactive among women, but only having a substance use disorder is associated with being unemployed among women. Among those with mental disorders, seeking health care services is less frequent within unemployed.
Resumo: Os transtornos mentais estão associados à situação laboral enquanto preditores significativos e consequências do desemprego e da aposentadoria precoce. Este estudo estima as taxas de prevalência de transtornos mentais nos últimos 12 meses de acordo com o DSM-IV, além do uso de serviços de saúde e as associações com situação laboral de acordo com gênero na Região Metropolitana de São Paulo, Brasil. Foram analisados dados do São Paulo Megacity Mental Health Survey (n = 5.037), um estudo populacional que avalia a prevalência e determinantes dos transtornos mentais entre adultos, usando a Composite International Diagnostic Interview. As associações foram estimadas através de razões de prevalência, obtidas por regressão logística binomial e multinomial. O estudo mostra que os transtornos mentais, especialmente transtornos de humor estão associados à inatividade ou ao desemprego entre os homens e à inatividade entre as mulheres, com exceção aos transtornos devido ao uso de substâncias psicoativas que também estão associados ao desemprego em as mulheres. Entre os portadores de transtornos mentais, a busca de serviços de saúde é menos frequente entre os desempregados.
Resumen: Los trastornos mentales están asociados a la situación laboral, como predictores significativos por las consecuencias que provocan el desempleo y la jubilación precoz. Este estudio estima las tasas de prevalencia de trastornos mentales en 12 meses, de acuerdo con el DSM-IV, además del uso de servicios de salud y las asociaciones existentes con la situación laboral, de acuerdo con el género en el área metropolitana de São Paulo, Brasil. Se analizaron los datos del São Paulo Megacity Mental Health Survey (n = 5.037), un estudio poblacional que evalúa la prevalencia y determinantes de los trastornos mentales entre adultos, usando la Composite International Diagnostic Interview. Las asociaciones se estimaron con razones de prevalencia, obtenidas por la regresión logística binomial y multinomial. El estudio muestra que los trastornos mentales, especialmente los trastornos de humor, están asociados a la inactividad o al desempleo en hombres y a la inactividad en mujeres, pero que sólo el trastorno de consumo de sustancias está asociado al desempleo en mujeres. Entre los portadores de trastornos mentales, la búsqueda de servicios de salud es menos frecuente entre los desempleados.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Aged , Young Adult , Employment/statistics & numerical data , Mental Disorders/epidemiology , Urban Population , Brazil/epidemiology , Sex Factors , Prevalence , Health Surveys , Health Services/statistics & numerical data , Middle AgedABSTRACT
ABSTRACT OBJECTIVE To identify the prevalence of 12-month self-reported pain and chronic pain in a general population and to describe their clinical profile to assess if chronic pain is associated with 12-month mental disorders. METHODS The data used comes from the São Paulo Megacity Mental Health Survey, a population-based study assessing adult (≥ 18 years) residents of the São Paulo metropolitan area, Brazil. We have assessed the respondents (n = 5,037) using the Composite International Diagnostic Interview (CIDI 3.0), with a global response rate of 81.3%. Descriptive analyses have been performed, and crude and adjusted odds ratios (OR) have been calculated with logistic and multinomial regression and presented with respective 95% confidence intervals (95%CI). RESULTS The prevalence of pain and chronic pain in the past 12 months were 52.6% (95%CI 50.3-54.8) and 31.0% (95%CI 29.2-32.7), respectively. Joints (16.5%, 95%CI 15.4-17.5) and back or neck (15.5%, 95%CI 14.2-16.9) were the most frequently reported anatomical sites of chronic pain. On a 10-point analogue scale, the mean intensity of the worst pain was 7.7 (95%CI 7.4-7.8), and the mean average pain was 5.5 (95%CI 5.2-5.6); the mean treatment response was 6.3 (95%CI 6.0-6.6). Mean pain duration was 16.1 (95%CI 15.6-17.0) days a month and 132 (95%CI 126-144) minutes a day. Chronic pain was associated with 12-month DSM-IV mental disorders (OR = 2.7, 95%CI 2.3-3.3), anxiety disorders (OR = 2.1, 95%CI 1.9-3.0), and mood disorders (OR = 3.3, 95%CI 2.4-4.1). CONCLUSIONS A high prevalence of chronic pain in multiple sites is observed among the general adult population, and associations between chronic pain and mental disorders are frequent.