042 SLEEP DISTURBANCES ASSOCIATED WITH PSYCHIATRIC MORBIDITY IN THE GENERAL POPULATION OF A LARGE METROPOLITAN AREA: RESULTS FROM THE SÃO PAULO MEGACITY MENTAL HEALTH SURVEY, BRAZIL

The São Paulo Megacity Mental Health Survey is a population-based cross-sectional survey of psychiatric morbidity, assessing a probabilistic sample of household residents in the São Paulo Metropolitan Area, aged 18 years and over. Respondents were selected from a stratified multistage clustered area probability sample of households, covering all 39 municipalities, without replacement. Respondents were assessed using the World Mental Health Survey version of the World Health Organization Composite International Diagnostic Interview (WMH-CIDI), which was translated and adapted into the Brazilian-Portuguese language. Data was collected between May 2005 and April 2007 by trained lay interviewers. The World Mental Health Survey version of the Composite International Diagnostic Interview comprises clinical and non-clinical sections, arranged as Part I and Part II, producing diagnoses according to the Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition, and the International Classification of Diseases - 10th Revision. Mood, anxiety, impulse-control and substance use disorders, and suicide-related behavior, considered core disorders, as well as socio-demographic information, were assessed in all respondents. Non-clinical modules and non-core clinical sections (obsessive-compulsive disorder, post-traumatic stress disorder, gambling, eating disorders, neurasthenia, pre-menstrual disorders, psychotic symptoms and personality traits) were assessed in a sub-sample (2,942 respondents), composed by all respondents with at least one core disorder and a 25% random sample of those who were non-cases. A total of 5,037 individuals were interviewed, with a global response rate of 81.3%. Saliva samples were collected from 1,801 respondents, with DNA extracted stored pending further investigations.

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Patterns and predictors of health service use among people with mental disorders in São Paulo metropolitan area, Brazil

Epidemiology and Psychiatric Sciences ◽

10.1017/s2045796016000202 ◽

2016 ◽

Vol 26 (1) ◽

pp. 89-101 ◽

Cited By ~ 7

Author(s):

Y.-P. Wang ◽

A. D. P. Chiavegatto Filho ◽

A. M. Campanha ◽

A. M. Malik ◽

M. A. Mogadouro ◽

...

Keyword(s):

Mental Health ◽

Mental Disorders ◽

Health Survey ◽

Metropolitan Area ◽

Sao Paulo ◽

Diagnostic Interview ◽

São Paulo ◽

Mental Health Survey ◽

Treatment Adequacy ◽

Complementary And Alternative

Aims.Important transformations in psychiatric healthcare (HC) delivery have been implemented in Latin America during the beginning of 21st century. However, information on current service uses patterns is scant, obstructing the estimates and proper planning of service needs for general population. The current investigation aims to describe patterns and estimates predictors of 12-month HC use by individuals with mental disorders in São Paulo metropolitan area, Brazil.Method.Data are from São Paulo Mental Health Survey, a cross-sectional multistage representative study. Participants were face-to-face interviewed in their household, using a structured diagnostic interview, the World Mental Health Survey Initiative version of the Composite International Diagnostic Interview. A total of 5037 respondents, non-institutionalised, aged 18 years and older were interviewed. The response rate was 81.3%. We determined the percentages of individuals with 12-month DSM-IV anxiety, mood and substance disorders that received treatment in the 12 months prior to assessment in main service sectors (specialty mental health, general medicine, human services (HS), and complementary and alternative medicine). The number of visits and percentage of individuals who received treatment at minimally adequacy also was estimated. Multilevel regression controlled contextual variables that influenced the use of service and treatment adequacy.Results.Only 10.1% of respondents used some HC service in the 12 months prior to assessment for their psychiatric problems, including 3.9% of them being treated either by a psychiatrist, 3.5% by a non-psychiatrist mental health specialist, 3.3% by a general medical (GM) provider, 1.5% by a HS provider and 1.4% by a complementary and alternative medical provider. In general, those participants who received service in the mental health specialty sector reported more visits than those in the GM sector (median 3.9 v. 1.5 visits). The cases seen in specialty sector outnumber those visiting GM treatment in terms of minimally adequate treatment (54.6 v. 23.2%). The likelihood of receiving treatment was significantly greater among individuals diagnosed with any anxiety and mood disorder, presenting more severe disorders, and with possession of HC insurance.Conclusions.The great majority of individuals with an active mental disorder in São Paulo were either untreated or insufficiently treated. Awareness and training programmes to GM professionals are advocated to improve recognition, care take and referral to specialty care when needed. Proper integration among HC sectors is recommended.

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