Helian Nunes de Oliveira

HIV, syphilis, and hepatitis B and C prevalence among patients with mental illness: a review of the literature

A limited number of studies worldwide have investigated the prevalence of HIV, syphilis, and hepatitis B and C infection among psychiatric patients. However, prevalence of these infections in the population with chronic mental illness has not been clearly established. Most of the published papers are from developed countries and have derived from relatively small and non-representative samples. We performed a systematic review of the published literature to identify studies on these infectious diseases within psychiatric populations in Brazil and other developing countries. Overall, prevalence rates varied from 0% to 29% for HIV; 1.6% to 66% for HBV; 0.4% to 38% for HCV; and 1.1% to 7.6% for syphilis. Several risk factors were identified and discussed, although sampling limitations restrict the generalization of study findings. This review highlights the lack of information on the prevalence of sexually transmitted diseases and their associated factors among persons with chronic mental illness and identifies gaps in the knowledge base in both developing and developed countries.

Reliability and validity of a questionnaire on vulnerability to sexually transmitted infections among adults with chronic mental illness: PESSOAS Project

OBJECTIVE To describe reliability/validity of a semi-structured questionnaire designed to assess risk behavior to sexually transmitted diseases among adults with chronic mental illness. METHOD A cross-sectional pilot study was conducted in one psychiatric hospital and one mental health outpatient clinic. Clinical, behavioral and demographic data were collected from semi-structured interviews and medical charts. One-hundred and twenty patients were randomly selected from pre-defined lists in both centers while 89 (74%) were interviewed, indicating 26% nonparticipation rate. Protocol, participation rates, consent form and feasibility issues were assessed. The semi-structured interview was evaluated with regard to reliability (intra- and inter-rater) and construct validity by randomly repeating the interviews in a 1:1 ratio up to one-week interval. Reliability was estimated by percent agreement and Kappa statistics (95% confidence interval). Construct validity was assessed by Grade of Membership model. RESULTS Kappa statistics ranged from 0.40 to 1.00 for most variables. Grade of Membership analysis generated three profiles. Profile one was represented by mostly women with no condom use in stable relationships; profile two revealed mostly men in stable relationship but with multiple risk behaviors; while profile three indicated a higher proportion of licit or illicit substance use. CONCLUSIONS Reliability and construct validity assessment using Grade of Membership analysis indicated that the semi-structured interview was suitable for capturing risk behavior among patients with chronic mental illness.

Correlates of hepatitis B among patients with mental illness in Brazil

OBJECTIVE To assess correlates of hepatitis B among adults with mental illness under care in Brazil. METHOD Cross-sectional national multicenter study of 2206 patients with mental illnesses randomly selected from 26 public mental health services. Sociodemographic and behavioral data were obtained from face-to-face interviews and psychiatric diagnoses from medical charts. Serology testing was conducted, and prevalence rate ratios were estimated by log-binomial regression. RESULTS The weighted prevalence rates of current hepatitis B virus (HBV) infection (HBsAg+) and previous HBV exposure (anti-HBc+) were 2.0% [95% confidence interval (CI): 1.5%-2.7%] and 17.1% (95% CI: 16.0%-19.0%), respectively. Correlates of HBsAg+ included male gender, younger age (18-29 years), unstable place of residence, intellectual disability, main psychiatric diagnosis of dementia, presence of other medical comorbitidy, use of alcohol/drugs during sex, more than one sexual partner and use of cocaine. Correlates of anti-HBc+ included male gender, older age (≥30 years), black skin color, lower education, unstable place of residence, currently hospitalized, intellectual disability, history of any sexually transmitted disease or syphilis, poor HIV knowledge, history of imprisonment and sexual violence. CONCLUSIONS Hepatitis B is an important comorbidity among psychiatric patients in Brazil. Screening for HBV, effective prevention and intervention strategies, including universal HBV immunization, should be routine practices in these mental health services.

Verbal violence against mentally ill individuals in Brazil: prevalence and associated factors

Considera-se violencia nao somente o abuso fisico ou sexual, mas tambem a violencia psicologica, que envolve a agressao emocional e a verbal1. A violencia verbal e o tipo mais frequente de violencia psicologica e ja foi avaliada em diversas populacoes, tais como as populacoes de criancas1, gestantes2, usuarias em servicos de saude3, trabalhadores e estudantes1. Nao ha estudos nacionais que avaliem a relacao da violencia verbal com transtornos mentais nos diversos tipos de servicos publicos de saude mental. Este trabalho avalia a prevalencia e os fatores associados aos autorrelatos de violencia verbal contra os individuos com transtorno mental, estratificando por sexo, em servicos de saude mental no Brasil.

Physical violence against patients with mental disorders in Brazil: sex differences in a cross-sectional study

OBJETIVOS: Pacientes com transtorno mental estao mais expostos a violencia do que a populacao em geral. Este estudo avaliou os fatores associados a violencia fisica na vida contra esses pacientes, por meio de analise estratificada por sexo, no Brasil. METODOS: Trata-se de estudo multicentrico nacional transversal, com amostra representativa de 2.475 pacientes selecionados aleatoriamente de 26 servicos publicos de saude mental. A regressao logistica foi utilizada para avaliar os fatores associados a violencia fisica, e odds ratio brutos e ajustados (ORa), com intervalo de 95% de confianca, foram estimados. O nivel de significância considerado foi de 0,05. RESULTADOS: A prevalencia na vida de violencia fisica contra pacientes com transtornos mentais foi semelhante para mulheres (57,6%) e homens (57,8%). A violencia fisica contra as mulheres esteve independentemente associada com: internacoes psiquiatricas anteriores (ORa = 2,09), historico de doenca sexualmente transmissivel (ORa = 1,75), historico de uso de alcool (ORa = 1,59), idade de iniciacao sexual (< 16 anos) (ORa = 1,40), historico de sexo sob efeito de drogas/alcool (ORa = 2,08), ter recebido/oferecido dinheiro por sexo (ORa = 1,73) e historico de encarceramento (ORa = 1,69). Entre os homens, os fatores associados foram: idade (18-40) (ORa = 1,90), historico de morar na rua (ORa = 1,71), internacao psiquiatrica anterior (ORa = 1,39), historico de doenca sexualmente transmissivel (ORa = 1,52), historico de consumo de alcool (ORa = 1,41), uso na vida de maconha ou cocaina (ORa = 1,54), ter recebido/oferecido dinheiro por sexo (ORa = 1,47), historico de encarceramento (ORa = 2,07). CONCLUSAO: A prevalencia de violencia fisica nessa populacao foi elevada para ambos os sexos. Embora haja fatores semelhantes independentemente associados a violencia fisica entre homens e mulheres, ha diferencas importantes, tais como a idade de inicio da vida sexual e o sexo sob uso de drogas/alcool para mulheres, mas nao para os homens. Ja para os homens, mas nao para as mulheres, o historico de morar na rua e o uso de maconha ou cocaina na vida estiveram associados ao evento. Triagem para a historia da violencia na admissao e intervencoes precoces para diminuir a vulnerabilidade sao necessarias nos servicos publicos de saude mental no Brasil.