Giovanni Marcos Lovisi

Poverty, violence and depression during pregnancy: a survey of mothers attending a public hospital in Brazil.

BACKGROUNDnDepression in women is associated with social deprivation and violence. We describe the prevalence and risk factors for depression during pregnancy, in particular the association with poverty and violence, in a Brazilian setting.nnnMETHODnA cross-sectional survey of women in the third trimester of pregnancy attending a public hospital maternity clinic from August 2003 to July 2004 in Rio de Janeiro. Participants were interviewed about their sociodemographic status, obstetric and medical conditions, substance use, stressful life events, and social support. Depression was diagnosed through the Composite International Diagnostic Interview (CIDI).nnnRESULTSnA total of 230 of 240 eligible women consented to participate. The 12-month prevalence of depression was 19.1% (95% CI 14.4-24.9). On multivariate analyses, having been educated beyond primary school was protective (OR 0.5, 95% CI 0.2-0.9). Risk factors were: being divorced or widowed (OR 4.9, 95% CI 1.3-18.3); a history of depression before pregnancy (OR 7.9, 95% CI 3.1-20.5); loss of an intimate relationship (OR 8.4, 95% CI 3.3-21.4), experienced financial difficulties (OR 6.6, 95% CI 2.5-17.2) and having been exposed to violence in the previous year (OR 4.2, 95% CI 1.5-11.8).nnnCONCLUSIONSnDepression is common during pregnancy and is associated with indicators of socio-economic deprivation, violence and the loss of an intimate relationship, and with a previous history of depression. Psychosocial interventions and appropriate social policies need to be implemented in this population to reduce the burden of maternal depression.

Análise epidemiológica do suicídio no Brasil entre 1980 e 2006

OBJECTIVE: The objective of this study was to carry out an epidemiological analysis of the suicide rates found in Brazilian regions and state capitals between 1980 and 2006. METHOD: Data on mortality rates due to suicide were collected from the Departamento de Informatica do Sistema Unico de Saude (Information Technology Department of the Brazilian Public Health System - DATASUS). RESULTS: A total of 158,952 suicide cases were registered between 1980 and 2006, excluding those cases in which the individual was less than 10 years old (n = 68). In the period under study, the total suicide rate in Brazil increased from 4.4 to 5.7 deaths per 100,000 inhabitants (29.5%). Higher average rates were found in the South (9.3) and Central-West (6.1) regions. Men were more likely to commit suicide. The highest suicide rates were found in the 70-years or above age range while the highest increases were found in the 20 to 59 year age bracket. The most dominant social-demographic characteristics of the persons who committed suicide in the period under study were low educational level and singlehood. The most common methods of suicide were hanging, fire arms and poisoning. CONCLUSION: Although in Brazil the rate increased 29.5% in 26 years, the national rate is still considered to be low when compared to worldwide suicide rates (average of 4.9 per 100,000 inhabitants). Suicide rates in Brazilian regions vary broadly, ranging from 2.7 to 9.3.

Prevalence of gestacional depression and associated factors

CONTEXTO: Depressao e um transtorno mental comum durante a gravidez, associado com diversos fatores de risco. Estudos revelaram relacao entre depressao gestacional e efeitos deleterios no desenvolvimento do bebe. OBJETIVOS: Revisar a prevalencia e os fatores de risco para a depressao durante a gravidez. METODOS: A revisao bibliografica considerou o periodo de 1997 a 2007 (Medline, Lilacs e Scielo), usando os descritores: depression during pregnancy OU gestational depression OU antenatal depression E prevalence E risk factors. RESULTADOS: A prevalencia de depressao durante a gravidez nos paises em desenvolvimento, incluindo o Brasil, foi mais alta que nos paises desenvolvidos, respectivamente, 20% e 15%. Apesar de ser uma importante questao de saude publica, ha poucos estudos sobre o tema no Brasil. Os principais fatores de risco foram: historia anterior de depressao, dificuldades financeiras, baixa escolaridade, desemprego, ausencia de suporte social, dependencia de substâncias e violencia domestica. CONCLUSOES: As implicacoes da nossa revisao para a pratica clinica consistem em enfatizar a necessidade de avaliacao da depressao e a investigacao de varios fatores de risco como parte do cuidado pre-natal por parte de obstetras e outros profissionais da saude. Alem disso, intervencoes psicossociais e politicas sociais necessitam ser implementadas nessa populacao.Background: Depression is a common mental disorder during pregnancy and is associated with several risk factors. Studies have reported an association between gestational depression and deleterious effects to the development of the infant. Objectives: To review the prevalence and risk factors for depression during pregnancy. Methods: The keywords: “depression during pregnancy” OR “gestational depression” OR “antenatal depression” AND “prevalence” AND “risk factors” were used to search for articles published between 1997 and 2007 in the MEDLINE, LILACS and SciELO databases. Results: The prevalence of depression during pregnancy in developing countries, including Brazil, was higher than in developed countries, respectively 20% and 15%. Despite being an important public health issue, there are few studies about this subject in Brazil. The main risk factors were: previous history of depression, financial difficulties, low level of education, unemployment, poor social support, substance dependence and domestic violence. Discussion: We emphasize the importance of the screening for depression in the context of antenatal care. Obstetricians and other related health care providers must be aware of the various risks factors for depression during pregnancy. In addition, psychosocial interventions and social policies need to be implemented in this population. Pereira PK, Lovisi GM / Rev Psiq Clín. 2008;35(4):144-53 Key-words: Depression, pregnancy, prevalence, risk factors. Endereço para correspondência: Priscila Krauss Pereira. Rua Alexandre Rosa, 14 – 21930-160 – Rio de Janeiro, RJ. E-mail: priscilakrauss@ig.com.br 145 Pereira PK, Lovisi GM / Rev Psiq Clín. 2008;35(4):144-53

Depression during pregnancy: prevalence and risk factors among women attending a public health clinic in Rio de Janeiro, Brazil

Depression is the most prevalent psychiatric disorder during pregnancy and is associated with psychosocial and clinical obstetric factors. Despite being an important public health issue, there are few studies about this issue in Brazil. A cross-sectional study was carried out, involving 331 pregnant women attending a public primary health service over a one-year period in Rio de Janeiro city, Brazil. Participants were interviewed about their socio-demographic status, obstetric/medical conditions, life events and violence during pregnancy. Depression was assessed using the Composite International Development Interview. The prevalence of depression during pregnancy was 14.2% (95%CI: 10.7-18.5) and associated factors included: previous history of depression and any psychiatric treatment, unplanned pregnancy, serious physical illness and casual jobs. These data emphasize the need for screening for depression and its risk factors during pregnancy in settings where care is available. Psychosocial interventions and social policies need to be devised for this population.

O trabalho em saúde mental: um estudo de satisfação e impacto

Knowledge of job satisfaction and work impact among psychiatric staff is highly useful for policymakers and mental health professionals. Since there are few studies on this issue in Brazil, a cross-sectional study was carried out among mental health professionals. Data were collected for 133 professionals from 4 mental health services in Rio de Janeiro, using SATIS-BR and IMPACTO-BR scales and a socio-demographic questionnaire. Statistical associations were analyzed using the Mann-Whitney, Kruskal-Wallis, and chi-square tests and multiple linear regression. SPSS 10.1 for Windows was used for statistical analyses. Mean satisfaction was 3.30 and mean work impact was 2.08 (on a scale from 1 to 5). 62.4% of subjects reported moderate satisfaction. Mental health workers with less schooling showed higher satisfaction. Work impact was not associated with any explanatory variable. The results for job satisfaction were similar to those of other studies. Work impact was very low. Unlike studies from the United States and Europe, there were no differences between the community-based and in-hospital staff.

Prevalence of mental disorders associated with suicide attempts treated at an emergency hospital in Rio de Janeiro, Brazil

There are few Brazilian studies on prevalence of mental disorders in suicide attempters. The available studies have mainly used secondary data and screening instruments. The principal objective of this study was to estimate the prevalence of mental disorders in 96 suicide attempters seen in an emergency ward in Rio de Janeiro, Brasil (2006-2007) using the Composite International Development Interview. Most were female, young, and illiterate, and the main method was ingestion of psychoactive drugs. Other factors included history of prior attempts and use of alcohol at the time of attempt. The most frequent mental disorders were: depression (38.9%), use of psychoactive substances (21.9%), posttraumatic stress disorder (20.8%), alcohol abuse (17.7%), and schizophrenia (15.6%). Total prevalence of mental disorders was 71.9%. These findings are largely consistent with studies conducted in other developing countries. Besides access to treatment for mental disorders, public policies with an emphasis on the control of suicide methods and social responses for the reduction of suicidal behavior are needed.

Complicações obstétricas, eventos estressantes, violência e depressão durante a gravidez em adolescentes atendidas em unidade básica de saúde

CONTEXTO: A depressao e um transtorno psiquiatrico comum entre as adolescentes gravidas e esta associada a diversos fatores de risco. OBJETIVOS: Estimar a prevalencia da depressao em adolescentes gravidas e identificar os principais fatores de risco. METODOS: Dados seccionais foram coletados de 120 gestantes adolescentes atendidas em uma unidade basica de saude do Rio de Janeiro. Os instrumentos utilizados foram o Composite International Diagnostic Interview (CIDI), para diagnosticar a depressao; a escala Stressful Life Events, para avaliar a presenca de eventos estressantes; o Abuse Assessment Screen (AAS), para o rastreamento de violencia contra a mulher durante a gestacao. RESULTADOS: A prevalencia de depressao gestacional foi de 14,2% (IC: 8,7-21,9), sendo os principais fatores associados: historia anterior de depressao, sangramento anomalo e hospitalizacao na atual gravidez, historia de acidente, incendio ou catastrofe e maus-tratos durante a vida. CONCLUSOES: Os resultados reforcam que a investigacao dos fatores de risco, o diagnostico e o tratamento da depressao devem ser parte integrante do atendimento pre-natal a adolescentes gravidas.

Suicidios e tentativas de suicidios por intoxicacao exogena no Rio de Janeiro: analise dos dados dos sistemas oficiais de informacao em saude, 2006-2008*

OBJECTIVEnTo describe the profile of suicide and attempts suicide by exogenous intoxication and completeness of data from the Center for Poisoning Control in Niterói City (CCIn), Information System for Notifiable Diseases (Sinan), and Mortality Information System (SIM) for Rio de Janeiro state (RJ).nnnMETHODSnIt was verified the frequency of suicide attempts and mortality in Rio de Janeiro state, period 2006-2008. The variables analyzed were sex, area of occurrence, circumstance, evolution, age, toxic agents and cause (ICD-10: X60-X69). The percentage of unknown information/blank was classified as excellent (≤ 10%), good (10 to 29.9%) and poor (≥ 30%). SPSS was used for statistical analysis.nnnRESULTSnNine hundred and forty records of attempts (CCIn) and 470 (Sinan) were analysed. The female and the age group of 20-39 years predominated, as well as use of toxic agents like medicines and pesticides. About suicide, were identified 33 records (CCIn), 23 (Sinan) and 180 (SIM). In CCIn were more frequent female and age group of 15-29 years, through Sinan and SIM from 40-59 years. For both events, psychotropic drugs accounted for more than 70% of drugs. The Sinan system has shown the worst performance for toxic agents.nnnCONCLUSIONSnDespite advances in improving the quality of information generated by the systems, problems regarding the coverage and data completeness remain committing the analysis of the magnitude of injuries. The study points out to the needs of systems compatibility and the improvement of the quality of information that are generated.Objective: To describe the profile of suicide and attempts suicide by exogenous intoxication and completeness of data from the Center for Poisoning Control in Niteroi City (CCIn), Information System for Notifiable Diseases (Sinan), and Mortality Information System (SIM) for Rio de Janeiro state (RJ). Methods: It was verified the frequency of suicide attempts and mortality in Rio de Janeiro state, period 2006-2008. The variables analyzed were sex, area of occurrence, circumstance, evolution, age, toxic agents and cause (ICD-10: X60-X69). The percentage of unknown information/blank was classified as excellent (≤ 10%), good (10 to 29.9%) and poor (≥ 30%). SPSS was used for statistical analysis. Results: Nine hundred and forty records of attempts (CCIn) and 470 (Sinan) were analysed. The female and the age group of 20-39 years predominated, as well as use of toxic agents like medicines and pesticides. About suicide, were identified 33 records (CCIn), 23 (Sinan) and 180 (SIM). In CCIn were more frequent female and age group of 15-29 years, through Sinan and SIM from 40-59 years. For both events, psychotropic drugs accounted for more than 70% of drugs. The Sinan system has shown the worst performance for toxic agents. Conclusions: Despite advances in improving the quality of information generated by the systems, problems regarding the coverage and data completeness remain committing the analysis of the magnitude of injuries. The study points out to the needs of systems compatibility and the improvement of the quality of information that are generated.

Substâncias tóxicas e tentativas e suicídios: considerações sobre acesso e medidas restritivas

Objective: This study aimed to estimate the frequency of the use of toxic substances as methods of suicide attempts and suicide for discussion of preventive measures and restrictions. Methods: Data on the mortality rates due suicide attempts and suicide were collected from the Mortality Information System (SIM) and Hospital Information System in Health System of Brazil (SIH-SUS) between 1998 and 2009. The variables analyzed were age, sex and underlying causes (ICD-10:xa0X60–X69). Results: Around 70.0% of the attempted suicide cases (SIH-SUS) had ingested toxic substances: medicines (46.2%), alcoholxa0(29.8%) and pesticidesxa0(15.1%). The following social-demographic characteristics were predominant in all analyzed cases: men andxa0agedxa0between 30 and 49 years. Regarding the suicide cases (SIM), the most frequently ingest substances were medicines (21.7%) and pesticidesxa0(28.3%), predominating adolescent women (3:1). The frequency of ingestion of pesticides was slightly more frequent in men (49.2%) than women (42.7%) but women ingested much more medicines than men (28.9xa0versusxa017.3%). Conclusion: Thexa0data indicated a young profile, and allowed the discussion of social acceptability and accessibility as determinants in the choice of methods used in the suicide attempts and suicide by poisoning. The study showed no strategic plans for suicide prevention were present but only specific actions for associated factors.

Depressão durante a gestação e os desfechos na saúde do recém-nascido: coorte de mães atendidas em unidade básica de saúde

OBJECTIVE: Describe the association between depression during pregnancy and effects on the newborn (low birth weight and prematurity). METHODS: We conducted a cohort study of 100 pregnant women enrolled between March and September 2011 in a public primary health service in Nova Iguacu. Participants were interviewed about their sociodemographic characteristics, medical/obstetric conditions, stressful life events and social support. Depression was assessed using the Composite International Diagnostic Interview (CIDI). After the post-partum mothers were interviewed about low birth weight and preterm birth. RESULTS: The prevalence of depression during pregnancy was 18% (95% CI: 12.2 to 23.8). Factors associated with neonatal outcome were gestational depression (OR: 6,60 CI: 1,51-28,91) and alcohol (OR: 8,75 CI: 1,10-69,71). CONCLUSION: The implications of this study to the practice emphasize the need for screening for depression during pregnancy.