Paulo Dalgalarrondo

The Strengths and Difficulties Questionnaire overseas: evaluations and applications of the SDQ beyond Europe.

Abstract.Background:During the few years that have passed since it became available, the Strengths and Difficulties Questionnaire (SDQ) has been extensively evaluated and widely applied to assess behaviour disorders of children and adolescents in European countries. In contrast, relatively few reports have published SDQ results obtained in other parts of the world, although its briefness and availability in over 40 languages make this instrument particularly attractive for international collaborations and cross-cultural comparisons concerning clinical and epidemiological issues.Objectives:This initial overview summarises some of these non-European experiences with the SDQ by presenting a selection of projects that have either psychometrically evaluated this novel questionnaire, applied it to screen for behaviour disorders, or employed its parent-, teacher- or self-rated versions as research tools. Since a large part of the mentioned studies are ongoing or have only recently been completed, much of the work reported here is still unpublished.Conclusions:Across a huge variety of cultures and languages, experience gained with the SDQ in other continents has supported European evidence of good psychometric properties and clinical utility of this questionnaire. Since worldwide usage of the SDQ can be expected to increase in the future, more international coordination is encouraged, in order to fully exploit the promising potentials of this versatile assessment tool and systematically investigate cross-cultural differences and similarities in child and adolescent behaviour.

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.

Uso de drogas psicotrópicas por estudantes: prevalência e fatores sociais associados

OBJETIVO: Determinar a prevalencia do uso pesado de drogas por estudantes de primeiro e segundo graus em uma amostra de escolas publicas e particulares, e identificar fatores demograficos, psicologicos e socioculturais associados. METODOS: Trata-se de um estudo transversal com uma tecnica de amostragem do tipo intencional comparando-se escolas publicas de areas perifericas e centrais e escolas particulares. Foi utilizado um questionario anonimo de autopreenchimento. A amostra foi constituida por 2.287 estudantes de primeiro e segundo graus da cidade de Campinas, SP, no ano de 1998. Considerou-se uso pesado, o uso de drogas em 20 dias ou mais nos 30 dias que antecederam a pesquisa. Para analise estatistica, utilizou-se a analise de regressao logistica politomica - modelo logito, visando identificar fatores que influenciem este modo de usar drogas. RESULTADOS: O uso pesado de drogas licitas e ilicitas foi de: alcool (11,9%), tabaco (11,7%), maconha (4,4%), solventes (1,8%), cocaina (1,4%), medicamentos (1,1%), ecstasy (0,7%). O uso pesado foi maior entre os estudantes da escola publica central, do periodo noturno, que trabalhavam, pertencentes aos niveis socioeconomicos A e B, e cuja educacao religiosa na infância foi pouco intensa. CONCLUSOES: Maior disponibilidade de dinheiro e padroes especificos de socializacao foram identificados como fatores associados ao uso pesado de drogas em estudantes.

Elevated thalamic and prefrontal regional cerebral blood flow in obsessive-compulsive disorder: a SPECT study

Functional neuroimaging studies have pointed to a possible role of cerebral circuits involving the prefrontal and anterior cingulate cortices, the striatum, and thalamus in the pathophysiology of obsessive-compulsive disorder (OCD). Regional cerebral blood flow (rCBF) of 16 drug-free Brazilian patients with OCD and 17 healthy subjects matched for age, gender, handedness and level of education was measured with [99m-Tc] HMPAO single photon emission computed tomography. Analysis of covariance identified four regions of interest with significantly higher rCBF: the right superior and inferior frontal cortex and the right and left thalamus. Positive correlations between symptom severity measured by Clinical Global Impression scores and rCBF were found in the right and left inferior frontal lobes and in the right basal ganglia. Compulsive behavior was inversely correlated with rCBF in the right thalamus, and duration of illness correlated positively with rCBF in the right and left superior frontal lobes and with the right thalamus. The findings of this SPECT study conducted in Brazil are in agreement with prior studies and provide additional support for the involvement of prefrontal-subcortical circuits in the pathophysiology of OCD. Furthermore, the study suggests that similar brain mechanisms appear to be involved cross-culturally.

Neuropsychological performance and regional cerebral blood flow in obsessive-compulsive disorder.

Convergent findings from neuropsychological and neuroimaging studies have suggested that neural dysfunction in frontal-subcortical circuits may play a central role in the pathophysiology of obsessive-compulsive disorder (OCD). To further examine the relationship between these two sets of findings we investigated both neuropsychological functions and regional cerebral blood flow (rCBF) in a combined study. Fourteen unmedicated patients fulfilling DSM-IV criteria for OCD and 14 healthy controls matched for age, gender, handedness, and education were assessed on neuropsychological tests that included Trail Making Test (TMT), Rey Complex Figure Test (RCF) (copy and 5-min recall), Verbal Fluency Test (VFT), and Wisconsin Card Sorting Test (WCST). rCBF was studied with 99 mTc-hexamethyl-propyleneamine-oxime (HMPAO) single photon emission computed tomography (SPECT). Patients performed more poorly than controls (P<.05) on RCF (copy), VFT, and WCST (perseverative errors). Spearmans correlations indicated that severity of OCD correlated inversely with performance on the RCF (copy and recall scores) and positively with rCBF in the right thalamus. Positive correlations were observed between nonperseverative errors (WCST) and rCBF in frontal areas and anterior cingulate. Perseverative errors (WCST) correlated negatively with rCBF in the right thalamus. These findings are consistent with most previously published studies and suggest neural dysfunctions in the frontal-subcortical circuits probably more pronounced in the right hemisphere. They also extend the existing research, showing associations between deficits in cortical-subcortical circuitry and performance on neuropsychological tests of controlled attention and visuospatial functions.

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.

Saúde mental, qualidade de vida e religião em idosos de um Programa de Saúde da Família

OBJETIVE: To evaluate the relations between dimensions of the socio-cultural life, such social support network, religion, mental health and the Quality of Life (QL) in a group of elderly people from the Family Health Program (FHP). METHODS: This study evaluated a sample of 82 elderly subjects (aged 60 or older), registered in a (FHP, and described the profile of physical and mental health, the functional capability and the QL, as well as demographic factors, socioeconomic and cultural associates to the dimensions. The instruments had been used: a sociodemographic schedule with detailed cultural, family and religion variables, MINI, WHOQOL-bref, and Barthel Index. RESULTS: Of the 82 subjects, 47 (57%) they were women and 35 (43%) men, being that 42 (51%) had age of 60 the 69 years and 40 (49%) 70 years or more. Through multivariable models, it was identified that the presence of mental disorder associates to only live it or with just one person. Poor QL was associated with not having a pension and having taken benzodiazepine in the last year. The religion showed to important dimension associate to the QV; In all domains of WHOQOL-bref, those who identified themselves as Protestant/Evangelicals showed worse scores. CONCLUSIONS: the present study it evidences that aged with less formal education and income, they tend to have QL and health worse.

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.

Altered states of consciousness and short-term psychological after-effects induced by the first time ritual use of ayahuasca in an urban context in Brazil.

Abstract This report describes psychological assessments of the first time ritual use of ayahuasca in the religious groups Uniāo do Vegetal and Santo Daime. Nineteen subjects who tried the beverage in Santo Daime rituals and nine subjects who tried it in Uniāo do Vegetal rituals were evaluated one to four days before their first ayahuasca experience in life and one to two weeks after this experience. Semistructured interviews and a structured psychiatric scale were used in the first evaluation to elicit set variables concerning attitudes towards the ayahuasca experience and to elicit mental health status. Mental health status was reassessed in the second evaluation, which also included a semistructured interview concerning the phenomenology of altered states of consciousness (ASCs). Predominantly positive expectancies concerning the ayahuasca experience were the most prominent findings concerning set variables. Visual phenomena, numinousness, peacefulness, insights and a distressing reaction were the most salient ASC experiences. A significant reduction of the intensity of minor psychiatric symptoms occurred in the Santo Daime group after the hallucinogen experience. Subjects in both groups reported behavioral changes towards assertiveness, serenity and vivacity/joy. The set and setting hypothesis, suggestibility processes, as well as the supposed unique effects of ayahuasca are used in discussing these findings.

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.