Helenice Bosco de Oliveira

Suicidal behavior in the community: prevalence and factors associated with suicidal ideation

OBJECTIVES To estimate the life prevalence rates of suicidal ideation, suicidal plans and suicide attempts and verify factors associated to suicidal ideation. METHODS 515 individuals > or = 14 years old were selected at random (cluster and stratified sample) and assessed by means of the WHO SUPRE-MISS interview, SRQ-20 and AUDIT. Life prevalence rates were estimated. Uni and multivariate analyses were performed. Odds ratios, together with confidence intervals, were adjusted by gender and age. RESULTS Life prevalence rates were 17.1% (95% CI: 12.9 - 21.2) for suicidal ideation, 4.8% (95% CI: 2.8 - 6.8) for plans and 2.8% (95% CI: 0.09 - 4.6) for suicide attempts. Only one-third of those who attempted suicide were later treated at a health facility. The 12-month prevalence rates were, respectively, 5.3% (95% CI: 3.5 - 7.2), 1.9% (95% CI: 1.0 - 2.8) and 0.4% (95% CI: -0.3 - 1.1). Suicidal ideation was more frequently reported by women (OR = 1.7), young adults (20-29 years old: OR = 2.9; 30-39 years old: OR = 3.6, compared to the 14-19 year old group), those living alone (OR = 4.2) and those presenting mental disorders (OR between 2.8 and 3.8). CONCLUSION The prevalence of suicidal behavior was similar to that found in most studies carried out in other countries. Suicidal ideation was consistently associated with factors related to mental disorders or psychological distress. This should be taken into account when developing strategies to prevent suicidal behavior.

Prevalence of alcohol abuse and associated factors in a population-based study

OBJECTIVE To estimate the prevalence of alcohol abuse/dependence and identify associated factors among demographic, family, socioeconomic and mental health variables. METHODS A household survey was carried out in the urban area of Campinas, southeastern Brazil, in 2003. A total of 515 subjects, aged 14 years or more were randomly selected using a stratified cluster sample. The Self-Report Questionnaire and the Alcohol Use Disorder Identification Test were used in the interview. Prevalences were calculated, and univariate and multivariate logistic analyses performed by estimating odds ratios and 95% confidence intervals. RESULTS The estimated prevalence of alcohol abuse/dependence was 13.1% (95% CI: 8.4;19.9) in men and 4.1% (95% CI: 1.9;8.6) in women. In the final multiple logistic regression model, alcohol abuse/dependence was significantly associated with age, income, schooling, religion and illicit drug use. The adjusted odds ratios were significantly higher in following variables: income between 2,501 and 10,000 dollars (OR=10.29); income above 10,000 dollars (OR=10.20); less than 12 years of schooling (OR=13.42); no religion (OR=9.16) or religion other than Evangelical (OR=4.77); and illicit drug use during lifetime (OR=4.47). Alcohol abuse and dependence patterns were different according to age group. CONCLUSIONS There is a significantly high prevalence of alcohol abuse/dependence in this population. The knowledge of factors associated with alcohol abuse, and differences in consumption patterns should be taken into account in the development of harm reduction strategies.

[Differences in mortality profile of tuberculosis patients related to tuberculosis-AIDS co-morbidity].

OBJECTIVE To analyze the profile of deaths among tuberculosis patients in Campinas, Brazil, between 1993 and 2000, describing TB-AIDS co-infection and the underlying cause of death in the annual cohorts grouped in two periods 1993-1996 and 1997-2000. METHODS A descriptive study of deaths was conducted among patients in Campinas, Brazil, who were being treated for tuberculosis and those reported as having TB after death. Data from the local Tuberculosis Registry and the Mortality Registry were used. Statistical analyses were performed using Epi Info version 6. Deaths were grouped in two periods (1993-1996 and 1997-2000) and then compared. RESULTS Of a total of 4,680 patients, there were 737 deaths. The fatality rate was 18.1% in the period 1993-1996 and 13.5% in 1997-2000. After death reporting for patients without treatment was seen in 78 deaths (10.6%). In both periods, there was a prevalence of male deaths (71.3%). TB-AIDS co-infection was found in 55% of deaths and their median age was 30-39 years while the median age was 50-59 years in those without AIDS. Those who were never treated for tuberculosis corresponded to 81.9%. CONCLUSIONS The most important finding was the significant reduction of deaths from 1997 onward that can be related to the introduction of AIDS antiretroviral therapy (HAART).

Social inequality and common mental disorders

OBJECTIVE To analyze the association between the socioeconomic characteristics of individuals and common mental disorders. METHOD A cross-sectional survey of a representative sample of the urban population, 14 years and older, in Campinas (Brazil) (n=515) was conducted using a multipurpose instrument that included the Self-Reporting Questionnaire (SRQ-20) to assess common mental disorders in the previous 3 months. Weighted prevalence of common mental disorders was calculated for each independent variable. Crude and adjusted prevalence ratios were estimated using Poisson regression. RESULTS The overall prevalence was 17% (95% CI 12.8-22.3), 8.9% in males and 24.4% in females. An inverse association was found between common mental disorders and the socioeconomic characteristics (schooling and employment) even after controlling for all the other variables. Higher common mental disorders prevalence was observed in those with less than 5 years of schooling (PR=5.5) and unemployed or underemployed (PR=2.0). CONCLUSIONS As in other studies, common mental disorders were unevenly distributed; it was significantly more frequent in socially disadvantaged individuals. Specific actions to reduce inequalities in the general and mental health system should be studied.

Prevalências de ideação, plano e tentativa de suicídio: um inquérito de base populacional em Campinas, São Paulo, Brasil

This study aimed to estimate the lifetime prevalence rates for suicidal ideation, suicide plans, and attempted suicide, based on a cluster sample of 515 residents of Campinas, São Paulo State, Brazil. The Multisite Intervention Study on Suicidal Behavior interview was performed, and lifetime prevalence rates and 95% confidence intervals (95%CI) were calculated. Lifetime prevalence rates were 17.1% (95%CI: 12.9-21.2) for suicidal ideation, 4.8% (95%CI: 2.8-6.8) for suicide plans, and 2.8% (95%CI: 0.09-4.6) for attempted suicide. Suicidal behavior was more frequent among women and young adults. The suicide plan/attempt ratio was approximately 5:3. Only one-third of those who attempted suicide contacted a health service following the attempt. Prevalence rates for suicidal behavior were similar to most studies from other countries. Suicide prevention strategies should take data from community-based studies into account.

Fatores associados à ideação suicida na comunidade: um estudo de caso-controle

This paper aims to identify variables associated with suicidal ideation during the previous 12 months in the city of Campinas, Sao Paulo, Brazil. Using a case-control design, risk factors for suicidal ideation were investigated through analysis of independent variables related to the individual, family, and health. Some 29 cases of suicidal ideation and 166 controls were interviewed. Cases were identified through a previous cross-sectional study, and controls were randomly selected from the same population base among those with no history of suicidal ideation in the previous 12 months. Regression models were used to control for confounders and effect modifiers. According to the results, demographic variables were not associated with suicidal ideation. In the final model, the variables that remained statistically significant were depressive symptoms, emotional difficulties, lack of neighborhood support, and less frequent church attendance. Suicidal ideation was consistently associated with factors related to depressive symptoms, especially lack of energy and depressed mood.

Recidivas em tuberculose e seus fatores de risco

The persistence of tuberculosis bacilli in patients who are cured, thus causing recurrence, is an important issue. This case-control study investigated individual and institutional risk factors for relapse by analyzing independent variables related to the patient, the use of antituberculosis drugs, and the service delivered at health care institutions; 56 cases and 105 controls were interviewed. Recurrence was defined as a new tuberculosis episode after the patient had been successfully treated. Controls were selected from among patients who were treated and cured of pulmonary tuberculosis and who did not experience a relapse. Regression models were proposed to control confounding factors or effect modifiers. The variables identified as risk factors for relapse were those related to erratic patient behavior (missing medical appointments and therefore not picking up the medication, not taking the medication, taking the wrong dosage), age, and stress from life events; adverse reactions to antituberculosis drugs; and problems in the organization of health care services that resulted in patients receiving insufficient dosages or amounts of antituberculosis drugs. Receiving information regarding treatment duration provided protection against recurrence. The knowledge regarding these risk factors should result in more intensive follow-up and in more use of directly observed treatment of tuberculosis in order to prevent relapse.

Análise do programa de controle da tuberculose em relação ao tratamento, em Campinas - SP

Descritores: Tuberculose. Abandono. Retratamento. Co-morbidade TB-AIDS.Key words: Tuberculosis. Treatment Refusal. Retreatment.Acquired Immunodeficiency Syndrome. ComorbidityIntroducao: A cura da tuberculose depende da adesao aotratamento.Objetivo: analisar o resultado do tratamento paratuberculose nos servicos publicos de saude de Campinas(SP), em 2002.Metodo: Foram investigados 436 pacientes de uma coortede 484 com diagnostico de tuberculose. O tipo deencerramento do tratamento foi descrito para pacientesnovos e em retratamento, para apresentacoes pulmonarese para co-morbidade com sindrome da imunodeficienciaadquirida (AIDS).Resultados: A taxa de sucesso foi de 68,6%, sendo 72,3%nos pacientes sem AIDS e 57,6% nos com AIDS. Nos casosnovos, o grupo sem AIDS teve 2,2 vezes mais chance deresultados favoraveis. No grupo com AIDS, nao se observoudiferenca entre novos e retratamentos. Nos insucessos, apenasa letalidade apresentou diferenca, 18,9% nos com AIDS vs8,0% nos sem AIDS. Nas formas pulmonares, o sucesso foisemelhante entre os inicialmente bacilo alcool-acidoresistente positivos e os demais.Conclusao: O programa de controle da tuberculose deCampinas apresentou baixa efetividade. Foi superior ada coorte nacional em 2001 para os sem AIDS, e inferiorpara os com AIDS. O sucesso entre os casos detuberculose sem AIDS derivou fundamentalmente dotratamento dos casos novos. O perfil desfavoravel datuberculose-AIDS, quanto a elevada letalidade (18,9%)e abandono (15,3%), foi responsavel, em parte, pela baixataxa de sucesso. Destacam-se as elevadas proporcoes deabandono numa cidade com facilidade de acesso paratratamento. Para melhorar o programa, deve-se investirna capacitacao das equipes em tratamentosupervisionado, educacao em saude e relacionamentocom os pacientes.Background: Tuberculosis cure is dependent upon treatmentadherence.Objective: To analyze the results of tuberculosis treatmentin public health clinics in the city of Campinas, in the stateof Sao Paulo, Brazil, during 2002.Method: From a cohort of 484 patients diagnosed withtuberculosis, we evaluated 436. Treatment outcomes were describedfor all patients, whether new patients or patients in retreatment,including those presenting the pulmonary form, with or withoutacquired immunodeficiency syndrome (AIDS) comorbidity.Results: The success rate was 68.6% (72.3% among non-AIDS patients and 57.6% among AIDS patients). Among newcases, the non-AIDS group presented a 2.2-times greater chanceof presenting favorable results. In the AIDS group, no differenceswere observed between new patients and those in retreatment.Among the unfavorable outcomes, only lethality presented adifference (18.9% among AIDS patients and 8.0% amongnon-AIDS patients). In patients presenting the pulmonary form,the success rate was similar between those who were initiallyacid-fast bacilli positive and those who were not.Conclusion: The tuberculosis control program in Campinaspresented low effectiveness. In comparison to the 2001 nationalcohort, success rates were higher for non-AIDS patients butlower for AIDS patients. The higher success rate among casesof tuberculosis without AIDS was primarily derived from thetreatment of new cases. The unfavorable profile oftuberculosis patients co-infected with AIDS, characterizedby the (18.9%) lethality and the (15.3%) noncompliance,were partially responsible for the lower success rate seenamong such patients. It is notable that such high proportionsof noncompliant patients were seen in a city providing easyaccess to treatment. In order to improve the program, medicalteams should receive further training in supervised treatment,health education and techniques for interacting with patients,all of which will require considerable investment.J Bras Pneumol 2005; 31(2): 133-8.

Percepção dos problemas da comunidade: influência de fatores sócio-demográficos e de saúde mental

A cross-sectional study was designed to identify which social problems from a list of 17 were considered important and to analyze differences in perception among interviewees according to socio-demographic variables and presence of common mental disorders. A household survey was performed in Campinas, São Paulo, Brazil, with a stratified cluster sample of urban residents aged 14 years or older (N = 515) using the WHO/SUPRE-MISS interview and SRQ-20. Weighted prevalence and crude prevalence ratio with respective 95%CI were calculated. Multiple analyses were performed using Poisson regression. Drug traffic, drug abuse, unemployment, crime, and alcohol abuse were considered severe by more than 45% of the sample. Women and individuals living in medium-low income areas attributed greater severity to drug traffic, alcohol and drug abuse, child and spousal abuse, unemployment, and poverty. Females and individuals with positive SRQ-20 identified problems related to education as more severe. Differences in perception according to socioeconomic status and gender were observed, with women and low-income residents showing the greatest susceptibility.

Suicide in Brazil, 2004-2010: the importance of small counties

OBJECTIVE To describe suicide rates by county size in the five geopolitical areas of Brazil. METHODS This was an ecological, descriptive study of suicide deaths in Brazil that occurred among the population 10 years of age and older in 2004-2010. Data were obtained from the National Mortality Information System of Brazil. Counties were defined by size as: very large (200,000+), large (< 200,000-100,000), medium (< 100,000-50,000), small (< 50,000-20,000), very small (< 20,000-10,000, and micro (< 10,000). Age-adjusted suicide rates were calculated for all counties and for population-size groups in each geopolitical area. Rate ratio and 95% confidence interval were used to compare suicide risk between groups and the reference. RESULTS The national, average suicide mortality rate was 5.7 deaths/100,000 inhabitants. Except in the North and North-East, suicide mortality rates increased from the very large (> 200,000) to the micro counties (< 10,000 population). Very high rates were scattered in the North and Mid-West among the indigenous peoples (> 30 deaths per 100,000). At highest risk were micro counties in the South (13.6 deaths per 100,000), with elderly males (60+ years, 31.4) and males 40-59 years (31.3) being the sex/age group with the highest rates. CONCLUSIONS To reduce suicide mortality in Brazil, public health authorities must support mental health training in small cities and multi-professional interventions among the indigenous peoples. In addition, the causes behind underreporting of suicide deaths must be resolved in several areas.