Section of Psychiatric Epidemiology-LIM 23, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil.
PLoS One. 2012;7(2):e31879. doi: 10.1371/journal.pone.0031879. Epub 2012 Feb 14.
World population growth is projected to be concentrated in megacities, with increases in social inequality and urbanization-associated stress. São Paulo Metropolitan Area (SPMA) provides a forewarning of the burden of mental disorders in urban settings in developing world. The aim of this study is to estimate prevalence, severity, and treatment of recently active DSM-IV mental disorders. We examined socio-demographic correlates, aspects of urban living such as internal migration, exposure to violence, and neighborhood-level social deprivation with 12-month mental disorders.
A representative cross-sectional household sample of 5,037 adults was interviewed face-to-face using the WHO Composite International Diagnostic Interview (CIDI), to generate diagnoses of DSM-IV mental disorders within 12 months of interview, disorder severity, and treatment. Administrative data on neighborhood social deprivation were gathered. Multiple logistic regression was used to evaluate individual and contextual correlates of disorders, severity, and treatment. Around thirty percent of respondents reported a 12-month disorder, with an even distribution across severity levels. Anxiety disorders were the most common disorders (affecting 19.9%), followed by mood (11%), impulse-control (4.3%), and substance use (3.6%) disorders. Exposure to crime was associated with all four types of disorder. Migrants had low prevalence of all four types compared to stable residents. High urbanicity was associated with impulse-control disorders and high social deprivation with substance use disorders. Vulnerable subgroups were observed: women and migrant men living in most deprived areas. Only one-third of serious cases had received treatment in the previous year.
Adults living in São Paulo megacity had prevalence of mental disorders at greater levels than similar surveys conducted in other areas of the world. Integration of mental health promotion and care into the rapidly expanding Brazilian primary health system should be strengthened. This strategy might become a model for poorly resourced and highly populated developing countries.
预计世界人口增长将集中在特大城市，社会不平等和城市化相关压力也将增加。圣保罗大都市区（SPMA）为发展中国家城市环境中心理障碍负担提供了预警。本研究旨在估计最近活跃的 DSM-IV 精神障碍的患病率、严重程度和治疗情况。我们研究了社会人口统计学相关因素、城市生活方面的因素，如内部迁移、暴露于暴力和邻里层面的社会剥夺与 12 个月精神障碍的关系。
采用世界卫生组织复合国际诊断访谈（CIDI）对 5037 名成年人进行了代表性的横断面家庭样本面对面访谈，以生成访谈后 12 个月内 DSM-IV 精神障碍、障碍严重程度和治疗的诊断。收集了邻里社会剥夺的行政数据。采用多变量逻辑回归评估个体和环境因素与障碍、严重程度和治疗的相关性。大约 30%的受访者报告了 12 个月的障碍，且严重程度分布均匀。焦虑障碍最为常见（影响 19.9%），其次是情绪障碍（11%）、冲动控制障碍（4.3%）和物质使用障碍（3.6%）。犯罪暴露与所有四种类型的障碍都有关。与稳定居民相比，移民的四种障碍患病率均较低。城市化程度高与冲动控制障碍有关，社会剥夺程度高与物质使用障碍有关。观察到弱势群体：生活在最贫困地区的女性和移民男性。只有三分之一的严重病例在过去一年中接受了治疗。
生活在圣保罗大都市区的成年人的精神障碍患病率高于世界其他地区进行的类似调查。应加强将精神健康促进和护理纳入快速扩张的巴西初级卫生保健系统。这一策略可能成为资源匮乏和人口众多的发展中国家的典范。
