Ronaldo Laranjeira

ADHD in a representative sample of the Brazilian population: estimated prevalence and comparative adequacy of criteria between adolescents and adults according to the item response theory

Background: Attention deficit hyperactivity disorder (ADHD) is a clinically significant disorder in adulthood, but current diagnostic criteria and instruments do not seem to adequately capture the complexity of the disorder in this developmental phase. Accordingly, there are limited data on the proportion of adults affected by the disorder, specially in developing countries.

Early life exposure to violence and substance misuse in adulthood—The first Brazilian national survey

BACKGROUND Substance misuse has been a major source of health and social problems in developing societies as it has been elsewhere. There is a growing body of evidence from developed nations linking early exposure to violence in childhood with substance misuse in adulthood. The role of depression on this association is not clear. This study estimates the association between early life exposure to violence, alcohol disorders and illegal substance use in adulthood and the role of depression on these associations using a national Brazilian sample. METHODS The first Brazilian National Alcohol Survey gathered information on early exposure to violence and use of psychoactive substances in 1880 participants aged 20 to 60 years old selected at random from the Brazilian household population. We used weighted logistic regression to calculate adjusted odds ratios for the associations between early exposure to violence and substance misuse. To assess the mediating effect of depression on these associations we used the Sobel-Goodman Mediation Test. RESULTS Witnessing violence during childhood or adolescence was reported by nearly 20% of the participants whilst over 8% reported having been victims of at least one form of violence. There was a statistically significant association between early exposure to violence and alcohol abuse and/or dependence and use of illegal substances in adulthood with a dose-response relationship. Depression partially explained the association between early exposure to violence with alcohol dependence (18.77% p<0.001) and did not have a statistically significant mediating effect on the association with illegal substance use (5.83% p=0.220). CONCLUSIONS Adverse early life events may affect individuals susceptibility to substance misuse which can be partially mediated by depression. Prevalence of substance misuse in adulthood may be in part attributed to the prevalence of adverse childhood experience. While prevention is the ideal goal, detection and intervention with children exposed to violence must be prioritised.

Gambling in Brazil: Lifetime prevalences and socio-demographic correlates

Gambling has experienced world-wide growth. The current study is the first national survey into household gambling conducted in a developing country. The sample was a three-stage probabilistic one designed to cover individuals 14 years old or older, of both genders and from all regions of the national territory; 325 census sectors were visited, including rural areas. DSM-IV-based instruments were used to assess problem and pathological gambling; individuals were asked to estimate their monthly gambling expenditure. The lifetime prevalences were: pathological gambling 1.0%, and problem gambling 1.3%. Maximum gambling expenditure corresponded to 5.4% of the household income for social gamblers, 16.9% for problem gamblers and 20.0% for pathological gamblers. The male:female ratio among adults for pathological gambling was 3.2:1. The data suggest the existence of two subgroups of pathological gamblers, one younger (33.9±4.19) and severe (7 or more DSM-IV criteria), another older (47.8±6.01) and less severe (5-6 criteria). In a multinomial logistic regression, problematic gambling was associated with gender, age, education, employment, region of origin and living in metropolitan areas. The data suggest that feeling active and socially inserted protects against problematic gambling. Individuals who are young, male, unemployed or not currently pursuing further education may be at special risk for severe pathological gambling.

Gambling onset and progression in a sample of at-risk gamblers from the general population

The goal of this study was to investigate gambling-related behavior, onset and progression in a sample of at-risk gamblers from the community. A national household survey was conducted in Brazil, covering individuals 14 years old or older. Subjects were screened for at-risk gambling, those testing positive answered a questionnaire about gambling progression, preferred games and DSM-IV pathological gambling criteria. Out of 3007 respondents, 118 were considered at-risk gamblers according to the Lie/Bet Questionnaire. According to the DSM-IV, 32.7% and 24.9% of those were considered problem and pathological gamblers, respectively. Early at-risk gamblers (onset prior to 20 years of age), were more likely to be male, to prefer non-commercially structured games, and to chase losses while gambling. Young pathological gamblers (under 35 years of age) progressed faster from regular to problem gambling (roughly 2 years) than mature pathological gamblers (12 years). Such findings had not been described before because previous reports focused mostly on clinical samples that lack young, male, early-onset gamblers. Gambling programs have not satisfactorily covered this segment of gamblers. Outreach strategies and early interventions should be provided to prevent these individuals from rapidly evolving into pathological gambling.