Mental illness in an adult sample admitted to public hostels in the Rio de Janeiro metropolitan area, Brazil.

BACKGROUND: The number of homeless people of any country is a major social and health issue, but to date only a few descriptive and focused studies have been undertaken in Brazil on the matter. METHOD: In order to fill this gap, a cross-sectional study was carried out in a random representative sample (n=330) out of 1,977 homeless people lodged in the five public hostels of the Rio de Janeiro metropolitan area. Full data were collected by two trained researchers in a face-to-face interview with 319 (96.7 %) out of the 330 lodgers, using the CIDI (Composite International Development Interview) to assess psychiatric diagnosis. RESULTS: The main findings concern prevalence rate of major mental illness, which was 19.4% for the 12 months before data collection, and 22.6% lifetime prevalence rate. Other 12-month prevalence rates were 31% for alcohol abuse/dependence, 4.1% for drug abuse/addiction, 15% for severe cognitive impairment, and 49.2% for any mental disorder. The rate was 65.2% when organic mental disorders were added. Moreover, 23.9% of the sampled lodgers reported previous psychiatric admission. Their demographic characteristics were a mean age of 44.8 years old, 75.8% of them were male, 78.9% were single, 94.7% had a low level of schooling, and 79.2% were long-term unemployed. CONCLUSIONS: This study demonstrates the high rates of psychiatric morbidity in the homeless, but these rates are exceeded by the apparent poverty and illiteracy of the sample. Given the lack of delivery of community services now in Brazilian cities, this group is likely to be marginalized. Some special teams to assess the hostel residents need to be created.

[The health status of Yanomámi Indians: diagnosis from the Casa do Indio, Boa Vista, Roraima, 1987 - 1989]. / A situação de saúde dos índios Yanomámi: diagnóstico a partir da casa do índio de Boa Vista, Roraima, 1987 - 1989.

The change in the morbidity profile of the Yanomámi Indians admitted to the Casa do Indio, at Boa Vista, Roraima, from January 1987 to August 1989, is reported. The most frequent diseases observed in 495 patients were malaria, acute respiratory infections, tuberculosis, severe under nutrition, and sexually transmitted diseases. Malaria was the main cause of death of 114 Indians throughout the period. A striking increase in hospital admissions was noted in the population from the villages which were in closer contact with gold miners. The global impact of the invasion of the Yanomámi territory by miners on the quality of life and health levels of the Yanomámi is discussed.

[The Guaraní-Kaiwá suicide epidemic: investigating its causes and suggesting the impossible return hypothesis]. / Epidemia de suicídio entre os Guaraní-Kaiwá: indagando suas causas e avançando a hipótese do recuo impossível.

The suicide of six young Guaraní-Kaiwá Indians within the timespan of two weeks is enough to fulfill any criteria to define an epidemic. In a total population of 7,500 individuals, the available data account for 52 cases of suicide between 1987 and August 1991. The epidemic is more dramatic among the Kaiwá subgroup among which 14 individuals died in 1990 and a number of suicides were reported for the first semester of 1991. For both sexes, most deaths were observed in the age group 12-20 years. The author advances the hypothesis of the impossible return according to which, under extreme pressure exerted by western society, they see no possibility of returning to their traditional way of living. Under circumstances of extreme self-devaluation, suicide becomes the last alternative for the survival of their culture. Suicide epidemics have been reported among Amerindians in other countries suffering from the same kind of pressure. In Brazil and also in other countries, other tribes have been urbanized and yet did not experience the tragedy which the Kaiwá are going through because they had some kind of acceptable insertion in the national society.