Dissertations / Theses on the topic 'Common mental disorder'

Background: Maternal common mental disorder (CMD), characterised by depression, anxiety and somatic symptoms of distress, is known to be an important health problem in low-and-middle-income countries, but had not been investigated in Malawi, Africa. In preliminary work, we adapted a CMD screening measure and showed that post-partum CMD was common and associated with child stunting. In the research presented here, we expanded the investigation of CMD in Malawi to include pregnant women and mothers of children with severe acute malnutrition (SAM). Using validated measures, we aimed to estimate the prevalence of antenatal CMD/depression and investigate its relationship to social support and intimate partner violence. Secondly, we sought to explore women’s lived experiences of the perinatal period. Finally, we investigated CMD amongst mothers of children admitted with SAM and other life-threatening illness and, in the former, we tested the hypothesis that maternal CMD would be associated with impaired child recovery. Method: In an antenatal clinic-based study, we validated and compared Chichewa and Chiyao versions of the Self Reporting Questionnaire (SRQ) and Edinburgh Postnatal Depression Scale (EPDS) using major depressive episode (MDE) as the criterion diagnosis. We adapted and validated the Multi-dimensional Scale of Perceived Social Support (MSPSS). We measured the prevalence of antenatal MDE and identified associated factors. We conducted focus group discussions with women and enquired about perinatal stressors and supports. We administered the SRQ to mothers of children with SAM during admission to a nutritional rehabilitation unit (NRU) and at 1-month post-discharge, and investigated whether CMD was a risk factor for lower child weight gain at follow-up. In a subsequent study, we compared levels of CMD symptoms between mothers of children admitted to a NRU, a high dependency unit and an oncology ward. Results: We found that the adapted EPDS and SRQ were both valid screening instruments for antenatal CMD/depression. The weighted prevalence of antenatal MDE was 10.7% (95% CI 6.9% - 14.5%). The adapted MSPSS showed adequate test characteristics and differentiated between sources of social support. MDE was associated with lack of support by a significant other; intimate partner violence moderated this association. We found that women in rural Malawi recognised depressive and anxious states in the perinatal period and identified lack of partner support as a key stressor. During admission with a severely malnourished child to a NRU, mothers had very high SRQ scores that greatly reduced post-discharge. There was no association between SRQ score and child weight gain at follow-up. We found no higher level of CMD symptoms amongst mothers of children admitted for treatment of SAM compared with those admitted to other wards. Conclusions: We demonstrated that measures of antenatal CMD and perceived social support can be adapted for use in Malawi. We found that maternal CMD is common and associated with lack of social support, intimate partner violence and child illness. We did not find evidence for a specific association between maternal CMD and child SAM but further prospective studies are required. Our findings suggest that treatment of CMD in mothers in Malawi will require attention to social support and partner behaviour.

Aims This thesis aimed to establish links between symptoms of common mental disorder in care-givers of patients with advanced disease and their subsequent experience of bereavement. r aimed to explore whether factors such as social support, family cohesion and religious beliefs which are probably protective against poor outcomes in care-giving, retain their protective effect during bereavement. Methods r conducted a cohort study. Informal carers of patients receiving palliative care at two hospices in South London were invited to participate. Carers were interviewed shortly after the patient was referred to the hospice (T1), using standardized assessment tools including the Revised Clinical Interview Schedule (CIS-R) and the Zarit Burden Interview. I also assessed carers' levels of social support, religious/spiritual beliefs, family relations, coping strategies and work and social adjustment as well as the patients' mood and quality of life. Interviews were repeated at 3 months and 6 months following the death of the care recipient using the Revised Clinical Interview Schedule (CIS-R), the Bereavement Phenomenology Questionnaire (BPQ) and the Quality of Death (QPD) scale. Results Of the] 00 carers who were interviewed at baseline, 46 carers agreed to be interviewed at T2 (three months post death) and 50 carersagreed to be interviewed at T3 (six months post death). Carers who suffered from more symptoms of common mental disorder while caring for their loved were at a higher risk of poor mental health outcomes at three and six months following the death of their loved one. Carers whose practical support needs were not met while caring for their loved one were more likely to experience symptoms of common mental disorder at six months post death. Conclusions This study demonstrates that it is possible to follow carers through to bereavement in a palliative care setting, however research in this context is highly challenging. The research suggests that much psychological distress detected during care-giving continues into bereavement. This has implications for the way in which caregivers are supported in this setting.

The common mental disorders of anxiety and depression (CMD) impose a substantial burden on individuals and society. A current limitation for research into risk factors for CMD is that the Mental Health Inventory -5 MHI-5) a brief but widely used scale to measure of anxiety and depression was designed without a cut-point to identify cases of CMD. This thesis designed a web-based epidemiological study. Changes in Well-being to gather data from MHI-5 and the Clinical Interview Schedule – Revised (CIS-R), representing the ‘gold standard’ for CMD case classification. From a random sample of 10,000 people aged 18 to 74 years living in Caerphilly County Borough, Wales a total of 616 participants were recruited. Of these, 82 (13.4%) were classified as CMD ‘non-severe’ (CMD-NS) using a CIS-R score of 12-17 and 129 (20.9%) were classified as a case of CMD ‘severe’ (CMD-S) with a CIS-R score of 18 and over. In an analysis of paired CIS-R and MHI-5 scores, the corresponding cut-points on the MHI-5 scaled of 0-100 were <60 and <45 respectively. These cut-points were applied to baseline and follow-up survey MHI-5 scores in the Caerphilly Health and Social Needs Longitudinal Study dataset to classify cases. Logistic regression analysis showed the importance of younger age, a range of major adverse life events, and living in the most deprived areas as risk factors for the onset of CMD. Adverse employment transitions, moving to non-owner-occupation and becoming widowed were more strongly associated with older age groups and living in areas of high social cohesion. This thesis has shown the utility of web-based epidemiological studies in population mental health, determined cut-points on the MHI5 scale and demonstrated the importance of a wide-range of risk factors for change in CMD case status.

Contexto: A influência das características do ambiente social de vizinhança nos transtornos mentais comuns (TMC) ainda é pouco estudada, principalmente em países em desenvolvimento como o Brasil, onde há poucos trabalhos sobre o tema. Objetivos: O objetivo geral foi investigar as relações entre as percepções de coesão social e segurança da vizinhança e transtorno mental comum, considerando-se as relações entre características individuais e de grupo bem como as medidas no nível agregado e no individual. Métodos: Essa pesquisa foi realizada com dados da linha de base (2008-2010) do Estudo Longitudinal da Saúde do Adulto - ELSA-Brasil, que é um estudo multicêntrico com 15.105 servidores civis, ativos e aposentados vinculados a seis instituições públicas de ensino superior e de pesquisa brasileiras. Foi utilizado o instrumento CIS-R, que permite rastrear o TMC e possibilita identificar seis categorias diagnósticas desse transtorno. Coesão social e segurança foram medidas por meio de escalas validadas de características autorreferidas de vizinhança. As covariáveis sexo, idade, estado civil, raça/cor, renda familiar per capita foram autorreferidas na entrevista de linha de base. O modelo de regressão de Poisson com variância robusta foi utilizado para estimar a razão de prevalência das associações entre os desfechos e as variáveis de exposição. Regressão logística multinível foi empregada considerando vizinhanças no nível 2 e os indivíduos no nível 1, para estimar o efeito aleatório de vizinhança e as razões de chance. Resultados: Resultados da percepção individual das características de vizinhanças indicaram associação entre pior percepção de coesão social e de segurança na vizinhança e transtornos mentais comuns, e essa associação permanece após o ajuste para as variáveis individuais, ou seja, participantes que percebiam morar em uma vizinhança com mais baixa coesão social e menos segura tiveram maior chance de apresentar TMC mesmo após ajustes para as covariáveis sociodemográficas. As variações entre as vizinhanças foram estatisticamente significativas no modelo vazio para TMC. Pequena porção da variância (2,3%) no TMC pode ser atribuída às vizinhanças. As estimativas de razão de chance obtidas no modelo mutiltinível mostraram uma variação significativa no TMC relacionada ao nível de coesão social e de segurança da vizinhança, que não pode ser totalmente explicada por fatores individuais, como sexo, idade, raça/cor, estado civil, escolaridade e renda familiar per capita. Conclusão: Esse estudo apresenta evidências da associação entre percepção de coesão social e segurança individual da vizinhança nos TMC, bem como entre as medidas agregadas da percepção de coesão social e segurança e TMC, mesmo após ajustes das variáveis individuais. Aproximadamente 2,3% da variabilidade na prevalência do TMC foram atribuídos ao contexto de vizinhança, e o restante ao nível individual, considerando o modelo “vazio”.
Context: The influence of the characteristics of the neighborhood social environment in common mental disorders (CMD), is poorly studied, mainly in developing countries such as Brazil, where there are few studies on the topic. Purposes: The general purpose was to investigate the relationships between the perceptions of social cohesion and neighborhood safety and common mental disorder, considering the relationships between individual and group characteristics as well as the ones measured in aggregate and individual level. Methods: This research was carried out using baseline data (2008-2010) from the Adult Health Longitudinal Study - ELSA-Brasil, which refers to the multicentric study with 15105 civil servants, active and retired ones linked to six Brazilian public higher education and research institutions. The instrument CIS-R was used which enables tracking the CMD and enables identifying six diagnosis categories of CMD. Social cohesion and safety were measured using validated scales of neighborhood self-referred characteristics. The covariates gender, age, marital status, race/color, per capita income were self-referred in the baseline interview. The Poisson regression model with robust variance was used to estimate the prevalence ratio of the associations between the outcomes and the exposition variables. Multilevel logistic regression was used considering neighborhoods in the level 2 and the individuals in the level 1 to estimate the neighborhood random effect and the chance ratios. Results: Individual perception results of neighborhood characteristics indicated association between worst perception of social cohesion and neighborhood safety perception and common mental disorders, and this association remains after the adjustment for the individual variables, that is, participants who noticed living at a neighborhood with lower social cohesion and less safe had a bigger chance to present common mental disorders even after adjustments for the socio demographic covariates. The variations between the neighborhoods were statistically significant in the empty model for CMD. A small portion of variance (2,3%) in the CMD can be attributed to the neighborhoods. The chances ratio estimates obtained in the multilevel model showed a significant variation in common mental disorders related to the level of social cohesion and neighborhood safety, which cannot be totally explained by individual factors such as gender, age, race/color, marital status, education and per capita income. Approximately 2,3% of variability in the prevalence of CMD was attributed to the neighborhood context and the rest to the individual level individual, considering the model as “empty”. Conclusion: This study presents evidences of the association between social cohesion and neighborhood individual safety perception in the CMD, as well as between the aggregate measures of social cohesion and safety perception and CMD, even after adjustment of the individual variables. About 2,3% of the variation in CMD prevalence was attributed to the context of neighborhood, and the rest to the individual level, considering the “empty” model.

I assessed common mental disorder (CMD) and its association with gender disadvantage among young women in two defined catchment areas (with contrasting socio-economic circumstances) in each city. Socio-economic status is a risk factor for CMD, and may confound or modify the effect of gender disadvantage, hence the stratified sampling. Female gender disadvantage cannot be measured directly, but is a well recognized phenomenon and has important effects across the life course. I used five proxy indicators; 1) no older brother at the time of birth (as a proxy for male preference), 2) limited parental bonding (low care and high overprotection), 3) low educational attainment 4) adverse marital circumstances (early age at marriage and low satisfaction) and 5) subjective perception. Recruitment and interviewing of 525 women aged 20-35 was completed with 98% response rate. 57% were married. The prevalence of CMD (SRQ score >=8) ranged from 26% (high SES Rawalpindi) to 83% (low SES Islamabad). Perception of parental preference for males, low care, less education, early age at marriage and low marital satisfaction were, as hypothesised, strongly correlated. I have found strong effects of all of the indicators of gender disadvantage (other than birth order) upon risk for CMD, independent of SES. I found strong evidence to support the main hypothesis of an independent association between low care and increased risk for CMD. However, for this risk factor the effect was modified by SES being significantly stronger among those living in higher SES districts.

Birth cohort studies offer an ideal setting to study disease across the lifespan. This thesis used data from the Medical Research Council National Survey of Health and Development, a study that has followed 5,362 individuals prospectively since their birth in 1946, and includes five assessments of mental health and four reports of treatment for mental disorder at various ages. Persistence or recurrence of symptoms of depression and anxiety in adolescence was associated with a poor long-term prognosis. A longitudinal model, that used a latent class analysis based on the five measures of mental health and was validated by considering several variables associated with mental health, identified six common patterns of experience of mental health from age 13 to 53. Differences between these six groups were traced back to birth; those who suffered from mental health difficulties were, on average, smaller at birth and reached developmental milestones later. The majority of individuals with mental disorder did not seek or receive treatment, and this did not change over several decades. There were few differences between individuals who sought treatment and those who did not, or those who were prescribed psychotropic medication and those who were not, apart from the severity and history of their symptoms. Despite this, those who did use antidepressants or anxiolytics during an episode of mental disorder had better mental health many years later. The research presented in this thesis contributes toward a life-course model of common mental disorders, and underlines the importance of taking a longitudinal perspective to better understand the aetiology, course, and outcome of mental illness and associated treatment.

Aims: To address gaps in the humanitarian needs assessment and mental health research field, the Humanitarian Emergency Settings Perceived Needs (HESPER) Scale was developed, a valid and reliable scale to assess the perceived needs of adult populations affected by humanitarian emergencies in low- and middle-income countries. Methods: A previously developed draft version of the HESPER Scale was pre¬tested in the United Kingdom (UK) with seven refugees from the Democratic Republic of the Congo (DRC), and was then pilot-tested in small samples (122 participants in total) with displaced Iraqi people in Jordan, and with the local populations in Gaza and Sudan, to assess the scale’s feasibility, intelligibility, comprehensiveness and cultural applicability, and to determine the suitability of training materials. A revised version of the HESPER Scale was subsequently field-tested in larger samples (817 participants in total) with displaced Iraqi people in Jordan, with people displaced following an earthquake in Haiti, and with Bhutanese refugees in Nepal, to assess its psychometric properties, as well as testing its application in measuring perceived needs and in providing data to predict mental health outcome. Results: Participants during pilot-testing found the list of HESPER items to be comprehensive and relevant, suggesting face validity and content validity of the scale. During field-testing, inter-rater reliability, test-retest reliability and internal consistency of the HESPER Scale was good to excellent across the three sites. Most HESPER items correlated as was predicted with related questions of both a quality-of-life instrument and a distress scale, demonstrating criterion (concurrent) validity of the scale. The HESPER Scale was also able to provide useful data on perceived needs in the three field-sites, with few gender differences. Number of perceived unmet needs and number of past traumatic events were both associated with symptoms of common mental.

Orientador: Maria Cristina Pereira Lima
Resumo: Introdução: A competência de juízo moral, baseada na teoria de Lawrence Kohlberg, tem sido estudada por muitos pesquisadores para avaliar o desenvolvimento moral de adolescentes e adultos. Pesquisas indicam que ocorre aumento da competência de juízo moral conforme o aumento da idade, maturidade e nível educacional. Apesar disso, resultados de estudos realizados com estudantes de medicina têm demonstrado que a competência moral desse público diminui conforme o curso avança. Até o presente momento, os principais motivos apontados para essa diminuição foram os currículos dos cursos, focados na formação tecnicista, além do ambiente de alta competição entre os alunos. Contudo, não encontramos na literatura pesquisas que verificassem se há associação entre competência moral e Transtorno Mental Comum. Objetivo: Descrever a relação entre competência moral e TMC de estudantes de medicina de uma instituição pública identificando fatores associados. Método: Trata-se de um estudo transversal. Participaram deste estudo alunos matriculados no curso de medicina de uma faculdade pública do interior do estado de São Paulo, que consentiram em participar da pesquisa. Para a coleta de dados foram utilizados os seguintes instrumentos: questionário que investiga aspectos sociodemográficos e da vida universitária; questionário para avaliação de Transtorno Mental Comum (TMC), o Self Reporting Questionnaire (SRQ-20); AUDIT (Alcohol Use Disorders Identification Test), instrumento de rastreamento criad... (Resumo completo, clicar acesso eletrônico abaixo)
Mestre

Introdução. Existem evidências comprovadas de uma estreita associação entre tabagismo e presença concomitante de transtornos psiquiátricos. A nicotina é uma droga estimulante, que faz com que o cérebro libere uma grande variedade de neurotransmissores, os quais podem propiciar ao fumante uma sensação prazerosa. Acredita-se que o ato de fumar possa afastar momentaneamente alguma situação estressante, distraindo o indivíduo de seus problemas. O conhecimento de fatores psicológicos e psiquiátricos associados ao tabagismo é importante para intervir no cuidado a estes indivíduos. Objetivo. Analisar a associação entre Tabagismo e Transtorno Mental Comum (TMC) na população com 16 anos e mais do município de São Paulo. Metodologia. Os dados foram obtidos através do Inquérito de Saúde do Município de São Paulo - ISA-Capital, realizado em 2003. Utilizando o módulo survey do pacote estatístico Stata 10, foi feita uma caracterização da prevalência de tabagismo e de TMC na população com idade igual ou superior a 16 anos. Para a análise da associação entre tabagismo e TMC utilizou-se o modelo de regressão de Poisson, por apresentar como medida de efeito a razão de prevalência, permitindo interpretações mais precisas. Resultados. A associação estatisticamente significativa entre tabagismo e TMC não foi encontrada na população geral, entretanto na análise univariada tal associação foi positiva para as mulheres (RP: 1,58; IC95 por cento: 1,06-2,37). Na análise múltipla a variável TMC perdeu significância estatística, não permanecendo no modelo final. Discussão. Historicamente, o contexto social positivo criado pela publicidade das indústrias tabageiras foi, muitas vezes, idealizador do comportamento de fumar. Além disso, sintomas da síndrome de abstinência da nicotina, como a ansiedade e a irritabilidade, podem contribuir para a manutenção do fumo. As campanhas anti-tabagistas têm contribuído para uma significativa mudança de paradigma, onde o tabagismo, de um comportamento elegante e charmoso, tem sido visto como um comportamento indesejável. Ainda assim, é alta a prevalência de tabagismo na população, independentemente do conhecimento do dano físico ou psicológico que causa. Considerações finais. As características psicológicas individuais são determinantes na iniciação e manutenção da dependência ao tabaco, e por isso o conhecimento da saúde mental/emocional dos tabagistas faz-se necessário na criação de programas de saúde voltados ao cuidado desses.
Introducion. There is proven evidence of a close association between somoking and concomitant presence of mental distress. Nicotine is a stimulant drug that causes the brain to release a wide range of neurotransmitters that may render the smoker a pleasant sensation. It is believed that the act of smoking may momentarily steer away a stressful situation distracting the individual from his problems. Knowledge on psychological and psychiatric factors associated to smoking is important for the intervention on behalf of the care for these individuals. Objective. Analysing the associaion between smoking and Common Mental Distress in the 16 year old and over population of São Paulo municipality. Method. Data were obtained though the São Paulo Health Inquiry Capital, carried out in 2003. The Stata 10 statistical package survey mode was used for the characterization of smoking and Common Mental Disorder (CMD) aged 16 and over. For the analysis of the association between smoking and CMD the Poisson regression model was used once it presents as effect measure the prevalence ratio, which allowed more precise interpretation. Result. A statistically significant association between smoking and CMD in the general population was not found but such association was positive with the univariate analysis for women (PR: 1.58; CI95 per cent: 1.06-2.37). With the multivariate analysis the CMD variable lost significant stastistic association, being discarded in the final model. Discussion. Historically, the positive social context concocted by the publicity campaigns of the smoking industries has been, at times, the idealisation tool for smoking behavior. Furthermore, nicotine absence syndorme symptoms such as anxiety and irritability may contibute to the maintenance of somoking. The anti-smoking campaigns have contributed to significative change of the paradigm, where smoking once depicted as elegant and charming has been seen as na undesirable behavior. Yet, the smoking prevalence is high in the population, irrespective of the kmowledge of physical or psychlogical harm it causes. Final Considerations. Individual psychologial characteristics are determinant of initiation and maintenance or tobacco dependence, and for this reason the knowledge on the mental/emotional health of smokers is deemed necessaty in the devising of health programs geared to their care

Orientador: Alessandro Ferrari Jacinto
Resumo: Introdução: O envelhecimento populacional é um fenômeno mundial que está associado ao aumento da incidência de doenças crônico-degenerativas, como as demências. As demências desafiam não somente os pacientes, mas também seus cuidadores. Em geral, cuidar de idosos é uma responsabilidade que pertence à esfera familiar. Como consequência, familiares cuidadores estão em maior risco de adoecimento mental, resultando em depressão, sobrecarga, sintomas ansiosos e transtorno mental comum. Objetivo: O presente estudo tem por objetivo verificar a prevalência de TMC em familiares cuidadores de pacientes idosos com diagnóstico de demência rotineiramente acompanhados nos ambulatórios de geriatria do Centro de Saúde Escola da Faculdade de Medicina de Botucatu, UNESP. Métodos: Neste estudo transversal, aprovado pelo Comitê de Ética e Pesquisa da Faculdade de Medicina de Botucatu os instrumentos de avaliação utilizados foram: Self Reporting Questionnaire, Hospital Anxiety and Depression Scale, Zarit Burden Interview, Mini Exame do Estado Mental para cuidadores com 65 anos ou mais, além de questionário para coleta de dados sociodemográficos. A variável de desfecho foi “com transtorno mental comum”, definida como pontuação ≥ 7 no Self Reporting Questionnaire. As variáveis explanatórias foram de natureza sociodemográfica e clínica do cuidador. Resultados: A amostra foi composta por 90 cuidadores; 83 (92,2%) era do sexo feminino, 51 (56,7%) casada, 60 (66,7%) filho (a) e 62 (68,6%) possuíam algu... (Resumo completo, clicar acesso eletrônico abaixo)
Mestre

Thesis (MPhil)-- Stellenbosch University, 2013.
ENGLISH ABSTRACT: Background: Health service utilization by people with mental health problems seem to be a large public health issue, especially in low-income countries. In Malawi, the situation is not different from other developing countries in Sub-Saharan Africa as far as access to services for people with mental health problems is concerned. Non specialized health care workers provide mental health services in the primary care settings in Malawi and, given the workload at primary health care (PHC) setting level, little time is available to screen for mental disorders, hence these may go unrecognized. Therefore, there is a possibility that a significant proportion of patients attending primary care in Malawi may have common mental disorders (CMD) and may be deprived of routine screening. Consequently, the possibility of misdiagnosis may lead to higher service utilization by people with common mental health problems. However, no study has been carried out to assess the health service utilization by people with common mental disorders in Malawi. Aim: The aim of the study was to evaluate health services utilization patterns of patients with CMDs in primary care clinics. Methods: This was a quantitative study employing a cross-sectional descriptive design. The study was conducted in two primary health care clinics in one of the 28 districts in Malawi. The study included all consecutive patients aged 18 years and older who attended the primary health care clinics for any reason. Face-to-face interviews using the Self-Reporting Questionnaires (SRQ-20) were conducted in a sample of 323 primary health care attendees. Findings: The prevalence of probable CMD was 20.1%. People with CMD had a higher average number of health facility visits in the previous three months compared to those without probable CMD thus 1.6 vs. 1.19 (p-value 0.02). There was no significant difference in the average number of traditional healer visits in the previous three months between those with probable CMD and those without thus 0.05 vs. 0.08 (p-value = 0.565). The total average number of both health facility and traditional healer visits was 1.68 vs. 1.24 (p-value 0. 019), people with probable CMD having a higher average compared to those without a probable CMD. It was found that people who have visited the health care facility repeatedly in the past 3 months were likely to be suffering from CMD. The odds of probable CMD increased with each visit to a health facility by 1.2 (p-value=0.024). Almost all those who had probable CMD had no treatment prescribed for CMD by PHC clinicians. Conclusion: The study reveals high utilization of health services for people with CMD, as well as a treatment gap of mental health care in primary care settings. PHC workers are misdiagnosing patients with CMDs leading to high utilization of PHC services. There is need for PHC workers to improve skills in diagnosing patients with CMD to make PHC services more effective by reducing re-attendances and improving patient outcomes. There is also need to direct effort towards creating awareness about mental health and encourage patient disclosure of psychological or mental health problems.
AFRIKAANSE OPSOMMING: Agtergrond: Dit blyk dat veral in lae-inkomste lande, die gebruik van gesondheidsdienste onder mense met geestesgesondheidsprobleme `n kwellende gesondheidskwessie te wees. Malawi, soos ander ontwikkelende lande in Sub-Sahara Afrika, ervaar die probleem van toegang tot gesondheidsdienste vir mense met geestesgesondheidsprobleme. In die primêre gesondheidsdienste in Malawi, word pasiënte met geestesgesondheidsprobleme behandel, deur algemene gesondheidswerkers wat nie gespesialiseerd is in geestesgsondheid. Verder veroorsaak die arbeidslas in primêre gesondheidsorg dat daar nie altyd tyd is om pasiënte voldoende vir geestesgversteurings te ondersoek nie. Dit is daarom moontlik dat `n merkwaardige aantal pasiënte wat gebruik maak van primêre gesondheidsorg in Malawi aan algemene geestesversteurings lei, maar hulle word nie voldoende ondersoek nie en gevolglik word hulle of nie gediagnoseer nie of verkeerdelik gediagnoseer. Dit kan daartoe lei dat `n groter aantal pasiënte, met algemene geestesversteurings, gebruik maak van primêre gesondheidsdienste. Die probleem is dat daar nog geen navorsing in Malawi gedoen is, oor die gebruik van gesondheidsdienste onder mense met algemene geestesversteurings. Doelwit: Die doel van die studie is om pasiënte, met algemene geestesversteurings, se gebruik van primêre gesondheidsorg klinieke te ondersoek. Metodes: `n Dwarssnee kwantitatiewe beskrywende studie-ontwerp was gebruik. Data-insameling het by twee primêre gesondheidsorg klinieke, in een van die 28 distrikte in Malawi, plaasgevind. Pasiënte, 18-jaar en ouer, wat die primêre gesondheidsklinieke vir enige rede besoek het, was ingesluit in die studie. Die steekproef het bestaan uit 323 pasiënte wat gebruik gemaak het van primêre gesondheidsorg klinieke. Onderhoude was met pasiënte gevoer deur middel van `n self-relaas vraelys (ook verwys na as „Self-Reporting Questionnaires‟). Bevindinge: Daar was `n voorkomssyfer van 20.1% pasiënte wat waarskynlik aan algemene geestesversteurings gelei het. Mense wat waarskynlik aan algemene geestesversteurings gelei het, het in `n tydperk van drie maande gemiddeld meer gebruik gemaak van gesondheidsdienste, in vergelyking met diegene wat waarskynlik nie aan algemene geestesversteurings gelei het nie, dus 1.6 teenoor 1.19 (p-waarde van 0.02). In die gegewe drie maande was daar geen betekenisvolle verskil in die gemiddelde aantal besoeke afgelê aan tradisionele geneeshere deur pasiënte wat waarskynlik aan algemene geestesversteurings gelei het, in vergelyking met diegene wat waarskynlik nie aan geestesversteurings gelei het nie, dus 0.05 teenoor 0.08 (p-waarde= 0.565). In totaal het diegene met geestesversteuring ook gemiddeld meer besoeke, 1.68 teenoor 1.24 (p-waarde 0.019), aan beide gesondheidsorg en traditionele geneeshere afgelê het, as diegene wat waarskynlik nie aan geestesversteurings gelei het nie. Die bevindinge dui daarop dat mense wat in die afgelope drie maande herhaaldelik gebruik gemaak het van gesondheidsdienste, waarskynlik aan algemene geestesversteurings gelei het. Die moontlikheid dat `n pasiënt aan `n algemene geestesversteuring gelei het, het met 1.2 (p-waarde=0.024) verhoog met elke besoek aan die gesondheidsdienste. Byna al die pasiënte wat waarskynlik aan `n algemene geestesversteuring gelei het, het nie behandeling ontvang nie. Gevolgtrekking: Daar is bevind dat mense met algemene geestesversteurings geredelik gebruik maak van gesondheidsdienste en dat daar `n gaping is in die voorsiening van geestesgesondheidsdienste in primêre gesondheidsfasiliteite. Primêre gesondheidsorg personeel se hantering van pasiënte lei daartoe dat pasiënte met algemene geestesversteurings meer geredelik gebruik maak van primêre gesondheidsorg. Daar is `n behoefte aan die verbetering van primêre gesondheidsorg personeel se vaardighede en vermoë om pasiënte met geestesversteuring te diagnoseer en sodoende ook herhaaldelike besoeke te verminder en die gesondheidsuitkomste van pasiente te verbeter. Daar is `n behoefte aan groter bewusmaking van geestesgesondheid en om pasiënte aan te moedig om hulle sielkundige en geestesgesondheidsprobleme aan personeel te openbaar.

Maternal mental disorders may influence the adequacy of care that a mother should have with their children, affecting their growth and development, increasing the risk for malnutrition or other nutritional problems. This study aimed to investigate the existence of association between maternal common mental disorders (CMD) and child nutrition. Cross-sectional study was conducted with 596 children 6-60 months of age and their mothers in 39 quilombolas communities of Alagoas. The maternal mental health was assessed by the Self Report Questionnaire (SRQ-20). We collected data on anthropometric, socioeconomic, demographic, health, use of public services and presence of comorbidities. The nutritional status was determined by anthropometric standards of World Health Organization (WHO) and diagnosed with short stature when Z <-2 for index height for age (H/A), and overweight/obesity when Z ≥ 2 for weight for height (W/H). To assess the nutritional status of mothers was used Body Mass Index (BMI) according parameter of the WHO. The findings found no association between maternal CMD and child nutritional status, but showed 65.3% of CMD among mothers of children under five years old, indicating a need for more studies that emphasize the role of maternal mental health as a possible risk to the child growth and development. However, we observed a high prevalence of nutritional deficiencies that persist as major public health problems in the state besides the strong presence of the nutritional transition, where malnutrition and obesity coexist with equal magnitude. Thus, interventions are needed in order to prevent, control and combat obesity and malnutrition, since both are health hazards.
Fundação de Amparo a Pesquisa do Estado de Alagoas
Os transtornos mentais maternos podem influenciar na adequação dos cuidados que uma mãe deve ter com seus filhos, afetando no seu crescimento e desenvolvimento, aumentando o risco para desnutrição ou outros agravos nutricionais. Este estudo teve como objetivo investigar a existência de associação entre o Transtorno Mental Comum (TMC) materno e o estado nutricional infantil. Realizou-se estudo transversal com 596 crianças de 6 a 60 meses de idade e suas respectivas mães em 39 comunidades quilombolas de Alagoas. A saúde mental materna foi avaliada pelo Self Report Questionnaire (SRQ-20). Foram coletados dados referentes às variáveis antropométricas, demográficas, socioeconômicas, de saúde, de utilização de serviços públicos e presença de morbidades. O estado nutricional infantil foi determinado pelo padrão antropométrico da World Health Organization (WHO) e diagnosticado com déficit estatural quando Z < -2 para o índice A/I e, sobrepeso/obesidade quando Z ≥ 2 para o índice P/A. Para avaliação do estado nutricional das mães foi utilizado o Índice de Massa Corporal (IMC) segundo os parâmetros da WHO. Os achados não encontraram associação entre TMC materno e estado nutricional infantil, mas mostrou 65,3% de TMC em mães de crianças com até cinco anos de idade, indicando necessidade de mais estudos que enfatizem o papel da saúde mental materna como possível risco para o desenvolvimento e crescimento infantil. Contudo, observaram-se altas prevalências de agravos nutricionais que ainda persistem como problemas de saúde pública importantes no estado além da presença marcante da transição nutricional, onde desnutrição e obesidade coexistem com idêntica magnitude. Assim, intervenções são necessárias com a finalidade de prevenir, controlar e combater a obesidade e a desnutrição, já que ambas são agravos à saúde.

Introdução: Obesidade central é um fator de risco para o diabetes e as doenças cardiovasculares. O estudo da sua associação com os transtornos mentais comuns pode ajudar a entender melhor a epidemia de obesidade que acontece no Brasil, e a relação entre saúde mental e doenças crônicas. Objetivo: Investigar a associação entre transtornos mentais comuns e obesidade central em uma coorte ocupacional- ELSA-Brasil. Métodos: Para a avaliação do transtorno mental comum (TMC) foi aplicado o questionário CIS-R em 15102 participantes entre 35 e 74 anos. A circunferência da cintura foi aferida junto com outras medidas antropométricas. Variáveis demográficas e comportamentais também foram coletadas através de questionários. Resultados: O transtorno mental comum mostrou associação com obesidade central (RP = 1,30; IC95% 1,25-1,36), e mesmo quando ajustada para sexo, idade, raça/cor da pele e centro de investigação ELSA, continuou significativa a associação (RP = 1,21; IC95% 1,16-1,27). Os transtornos específicos depressão (RP = 1,24, IC95% 1,14-1,34), ansiedade (RP = 1,18, IC95% 1,12-1,24) e misto de ansiedade e depressão (RP = 1,12; IC95% 1,06-1,18) também se mostraram associados, inclusive quando ajustados para as mesmas covariáveis. Conclusão: Participantes com transtorno mental comum e com os diagnósticos específicos de depressão e ansiedade apresentam maior prevalência de obesidade central comparados com os que não apresentam transtornos mentais.
Background: Central obesity is a risk factor for diabetes and cardiovascular disease, and the study of its association with common mental disorders can help understand the obesity epidemic in Brazil, and the relationship between mental health and chronic diseases. Objective: To investigate the association between common mental disorders and central obesity in an occupational cohort ELSA-Brasil. Methods: Waist circumference, among other anthropometric measures, was obtained, and the CIS-R questionnaire was applied in 15102 participants between 35 and 74 years old. Demographic and behavioral variables were also obtained. Results: Common mental disorder was significantly associated with central obesity in crude analysis (PR = 1,30, CI95%: 1,25-1,36), and when adjusted for gender, age, skin color and center study (PR = 1,21, CI95%: 1,16 – 1,27). The specific mental disorders depression and anxiety were also associated. Conclusion: Participants with common mental disorder, and with specific diagnoses of depression and anxiety, report a higher prevalence of central obesity than people without a mental disorder.

Syfte och frågeställningar: Syftet med studien var att utifrån ett salutogent perspektivundersöka professioners uppfattningar om och yrkeserfarenheter av att upptäcka tidigasignaler på stress och hur dessa kan hanteras. De frågeställningar som besvaras är; I) Vilkauttryck tar sig dagens psykiska ohälsa i arbetslivet? II) Hur kan individen upptäcka tidiga varningssignaler på stress? III) Vilka strategier kan individen tillämpa för att främja sin förmåga att hantera stress? IV) Vad anses vara hälsofrämjande på de olika systemnivåerna?Metod: Studien utgår ifrån en kvalitativ forskningsmetod med inspiration av den fenomenografiska ansatsen. Metoden för insamlad data bestod av semistrukturerade intervjuer. Resultat: Resultatet har presenterats i fyra huvudkategorier - Gränslöst arbete, Tidiga varningssignaler på stress, Hantering av stress, Hälsofrämjande arbetssätt, tillsammans med åtta subkategorier - Ett individualistiskt samhälle, Krav och prestationer, Bakomliggande orsaker, En mindre hållbar situation, Individens egna val, Individ- och gruppnivå, Organisationsnivå, Samhällsnivå. Konklusion: Symptom som trötthet, oro och sömnsvårigheter är varningssignaler på stress. Att arbeta med hälsofrämjande insatser på ett tidigt studium är en framgångsfaktor som respondenterna talar om. Det är viktigt att vara lyhörd för tidiga symptom och bakomliggande orsaker, det vill säga att ta reda på "vad det är som prasslar".
Purpose and issues: The purpose of the study was to examine, from a salutogenic perspective, professionals' perceptions and work experiences of detecting early signals on stress in working life and how they can be managed. The questions to be answered are: I)What are the expressions of mental illness in working life today? II) How can the individual discover early warning signals on stress? III) What strategies can the individual apply to promote his/her ability to cope with stress? IV) What is considered to be a health promotionfor the different system levels? Methods: The study design is qualitative inspired by the phenomenographic approach. Semistructured interviews were used for collecting data. Results: Four main categories emerged - Borderless work, Early warning signals of stress, Managing stress, Working in a health promotion manner. Eight subcategories were found –An individualistic society, Demands and achievements, Underlying causes, An unsustainable situation, The individual's own choices, Individual- and group level, Organizational level and environmental- and societal level. Conclusion: Symptoms such as fatigue, anxious and insomnia are warning signals of stress. Working in a health promotion manner in early stages is a success factor mentioned by the respondents. It is important to be responsive to early symptoms and underlying causes, that is, to examine "what is the rustle".

This thesis initially focuses on primary mental health provision within the community across common mental health disorders. It analyses a data set of Improved Access to Psychological Therapies (IAPT) service users from the North East Essex IAPT service Health in Mind. The analysis initially focuses on identifying predictors for referrals, non-attendance (did not attend/DNA) and levels of engagement. Following on from this examination of the data further analysis is undertaken on success assessment for the service users in the data set. An alternative assessment criterion is proposed and explored. Next, in response to increased pressure on NHS resources and services and to explore why certain client groups have high levels of non-engagement, the thesis then explores the specific mental health disorder of Post-Traumatic Stress Disorder (PTSD) in a client group of British Military Veterans. A series of three pilot studies (angling, falconry/archery and equine intervention) are carried out to explore the validity of a proposed new intervention to reduce PTSD symptomology, Peer Outdoor Exposure Therapy (POET). To extrapolate the learning achieved through the pilot studies a Random Control Trial (RCT) was executed looking at the efficacy of POET when utilising the most effective of the pilot study formats, angling. To enhance the knowledge obtained through the RCT a thematic analysis of four in depth interviews with participants from the study, thirty three months after their attendance, was utilised to help formulate a psychological model of the effect of POET.

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Introdução: O sofrimento psíquico atinge grande parte da população, e pode ser caracterizado por um acentuado e duradouro desconforto emocional, angústia, tristeza, falta de expressão afetiva, esgotamento emocional, isolamento social, dentre outros sintomas. Os estudantes universitários, especialmente da área da saúde, carregam expectativas diversas em relação ao futuro profissional e no decorrer de sua formação são expostos às mais variadas situações que mobilizam seu sofrimento psíquico, podendo vir a comprometer tal formação. Objetivo: Estimar a prevalência e identificar os fatores associados a Transtorno Mental Comum (TMC), entre os estudantes universitários da área da saúde, dos cursos de Enfermagem e Medicina da Faculdade de Medicina de Botucatu e de Nutrição do Instituto de Biociências. Método: Este é um estudo transversal que se insere na pesquisa “Condições de vida e saúde de estudantes de Enfermagem, Medicina e Nutrição do campus de Botucatu”, cujos dados foram colhidos em 2013. Trata-se assim, de uma análise parcial do referido banco de dados. A variável dependente é TMC, investigada a partir do Self Report Questionnaire, considerando-se caso mulheres com 8 pontos ou mais e homens com 6 pontos ou mais. As variáveis independentes são as características sociodemográficas e rede de apoio avaliada pela Escala de Apoio Social (EAS). Inicialmente foi feita análise descritiva, seguida de análise bivariada e posteriormente foram construídos modelos de regressão logística para cada um dos cursos. Foi adotado o nível de significância estatístico de p < 0,05, para rejeição da hipótese de nulidade. Resultados: Nos três cursos a taxa de resposta foi superior a 80%. A prevalência de TMC foi 40,9%, sendo significativamente diferente (p<0,001): 57,5% na Enfermagem, 40,7% na Medicina e 26,6% na Nutrição. Após a análise multivariada mostraram-se fatores de risco para TMC conforme questionário, na Enfermagem: pensar ou ter pensado em abandonar o curso e na Nutrição, pensar ou ter pensado em abandonar o curso e ter dificuldade para fazer amigos; conforme Escala de Apoio Social menor escore na Enfermagem de apoio interação e na Medicina e Nutrição de apoio informação. Em todos os cursos sentir-se rejeitado mostrou-se associado a TMC. Conclusão: A prevalência de TMC foi elevada e associou-se a aspectos relativos a apoio social e relacionamento com pares. Estratégias que aprimorem o relacionamento interpessoal podem auxiliar os alunos no manejo de seu sofrimento psíquico.
Background: The psychological distress affects a big part of the population, and can be characterized by an accentuated and lasting emotional distress, anxiety, sadness, lack of emotional expression, emotional exhaustion, social isolation among other symptoms. College students, especially in the health field, carry different expectations about the professional future and during their course are exposed to various situations that mobilize their psychological distress that may compromise their studies. Objective: To estimate the prevalence and identify factors associated with Common Mental Disorder (CMD) among university students in the health area, at Medicine and Nursing courses of Botucatu Medical School and Nutrition at the Institute of Biosciences. Method: This is a cross-sectional study that is part of the survey "Conditions of life and health of Nursing, Medicine and Nutritian at Botucatu campus", whose data were collected in 2013. It is a partial analysis of that database. The dependent variable is CMD, investigated by the Self Reporting Questionnaire, considering “case” women with 8 points or more and men with 6 points or more. The independent variables are: demographic characteristics and support network assessed by Social Support Scale. Initially descriptive analysis was performed, followed by bivariate analysis and finally, logistic regression models were run for each of the courses. The statistical significance adopted was p <0.05 to reject the null hypothesis. Results: In the three courses the response rate was over 80%. The prevalence of CMD was 40.9% and was significantly different (p <0.001): it was 57.5% in Nursing, 40.7% in Medicine and 26.6% in medical nutrition. After multivariate analysis, the risk factors observed for CMD as questionnaire in Nursing: think or have thought to leave the course and Nutrition, think or have thought to leave the course and find it difficult to make friends; as Social Support Scale lowest score in Nursing support interaction and Medicine and Nutrition support information.In all the courses feel rejected was associated with CMD. Conclusion: The prevalence of CMD was high and was associated with aspects of social support and relationship with peers. Strategies that improve interpersonal relationships can help students to deal with their mental suffering.

Orientador: Maria Cristina Pereira Lima
Resumo: Introdução: O sofrimento psíquico atinge grande parte da população, e pode ser caracterizado por um acentuado e duradouro desconforto emocional, angústia, tristeza, falta de expressão afetiva, esgotamento emocional, isolamento social, dentre outros sintomas. Os estudantes universitários, especialmente da área da saúde, carregam expectativas diversas em relação ao futuro profissional e no decorrer de sua formação são expostos às mais variadas situações que mobilizam seu sofrimento psíquico, podendo vir a comprometer tal formação. Objetivo: Estimar a prevalência e identificar os fatores associados a Transtorno Mental Comum (TMC), entre os estudantes universitários da área da saúde, dos cursos de Enfermagem e Medicina da Faculdade de Medicina de Botucatu e de Nutrição do Instituto de Biociências. Método: Este é um estudo transversal que se insere na pesquisa “Condições de vida e saúde de estudantes de Enfermagem, Medicina e Nutrição do campus de Botucatu”, cujos dados foram colhidos em 2013. Trata-se assim, de uma análise parcial do referido banco de dados. A variável dependente é TMC, investigada a partir do Self Report Questionnaire, considerando-se caso mulheres com 8 pontos ou mais e homens com 6 pontos ou mais. As variáveis independentes são as características sociodemográficas e rede de apoio avaliada pela Escala de Apoio Social (EAS). Inicialmente foi feita análise descritiva, seguida de análise bivariada e posteriormente foram construídos modelos de regressão logística... (Resumo completo, clicar acesso eletrônico abaixo)
Mestre

Introdução: A hipertensão arterial é de causa multifatorial, envolvendo hábitos de vida e estilos de vida inadequados como o consumo excessivo de bebida alcoólica que propiciam a elevação dos níveis pressóricos. Além disso, os sintomas relacionados ao transtorno mental comum também podem se associar ao estado de saúde, provocando mais danos ao sujeito com hipertensão arterial. Diante disso, o presente estudo teve como objetivo principal identificar associação entre a ocorrência de hipertensão arterial com o consumo de bebidas alcoólicas e a presença de transtorno mental comum em indígenas das aldeias Muras, residentes em região rural e urbana. Casuística e Métodos: Estudo transversal, de base populacional, com 455 indígenas Mura residentes no município de Autazes, Amazonas, Brasil. Foi aplicada a entrevista semi-estruturada com questões referentes aos dados socioeconômicos e educacionais, hábitos de vida, história clínica, histórico familiar, além dos questionários Alcohol Use Disorders Identification Test (AUDIT) e Self-Reporting Questonnaire (SRQ-20), para avaliar o consumo de álcool e presença de transtorno mental, respectivamente. A pressão arterial foi medida com aparelho automático de braço validado. Foram realizadas três medidas e usada a média das duas últimas medidas. Realizaram-se ainda, medida do peso, altura, circunferência do pescoço, circunferência da cintura, avaliação de bioimpedância; glicemia, triglicérides e colesterol com medida capilar. Na análise bivariada, foi testada a associação entre hipertensos, separadamente, com os dois desfechos: consumo de bebidas alcoólicas e a presença de transtorno mental comum explorando especialmente, os aspectos relacionados à hipertensão arterial. Foi ajustada a regressão de Poisson com variância robusta, para ambos os desfechos, com modelagem em stepwise backward automatizado, tendo como critério de entrada, p<0,20 e de significância no modelo final, p0,05. Utilizou-se como estimativa, as razões de prevalência e respectivos intervalos de confiança de 95%. Resultados: A maioria dos participantes era do sexo feminino (57,8%), com 42,10 (16,74) anos, vivendo com companheiro (74,7%) e cerca de quatro filhos por família, baixo nível de escolaridade Analfabeto/Fundamental incompleto (41,1%) e renda até dois salários mínimos (85,0%). A prevalência de hipertensão arterial foi de 26,6%, tabagismo (20,4%) e ser sedentário/irregularmente ativo (52,8%). O consumo de bebida alcoólica foi de 40,2%, sendo 13,4% classificados como alto risco para dependência alcoólica, e maior na área rural em comparação à urbana (57,3% vs 22,2%) p<0,001. Destacam-se os seguintes aspectos do uso abusivo de álcool: sentimento de culpa/remorso (45,9%); amnésia repentina por não lembrar o ocorrido na noite em que bebeu (31,7%); além de machucar-se ou sentir-se prejudicado por causa da bebida (29,6%); preocupação por parte de parentes, amigos ou profissionais de saúde, que aconselharam o entrevistado a interromper o consumo (51,5%). Não houve associação entre a presença e consumo de bebida alcoólica (23% e 26%). Os indígenas com diagnóstico de hipertensão referida, faziam menos uso de bebida alcoólica (14,2%vs 85,8%, p=0,009), porém nas ocasiões em que bebiam, ingeriam maior quantidade, comparado com os que não referiram hipertensão [55,3(72,2) vs 33,3(62,2) gramas de Etanol p=0,008]. A prevalência de transtorno mental comum foi de 45,7%, com destaque para os seguintes itens: referência de dores de cabeça frequentes (69,5%), sentir-se nervoso, tenso ou preocupado (66,2%), ter se sentido triste ultimamente (56,0%), dormir mal (55,2%) e ter sensações desagradáveis no estômago (42,9%). Além disso, destaca-se que 7,3% referiram ideia de acabar com a própria vida e 4,2% sentiram-se incapazes de desempenhar papel útil. Após análise ajustada a razão de prevalência após análise ajustada (Razão de prevalência, IC-95%), verificou-se associação positiva entre ingestão de bebida alcoólica e sexo masculino (2,72, IC-2,12-3,48), tabagismo (1,29, IC-1,06-1,56) e morar na zona rural (2,09, IC-1,61-2,72). Porém, a ação foi protetora para idade (0,98, IC-0,98-0,99), consumo de alimentos in natura (0,97, IC-0,95-0,99), e ausência de dislipidemias (0,75, IC-0,62-0,9). Entre os que apresentaram transtorno mental comum, a hipertensão arterial identificada esteve presente em 30,3% e o consumo de álcool uma vez ao mês em 22,1%. Após a análise ajustada (Razão de prevalência, IC-95%) verificou-se associação positiva entre o transtorno mental comum e a zona de moradia urbana (1.25, IC-1,02-1,54), não sabia que tinham antecedentes para diabetes (1.56, IC-1,24-1,96) e a ingestão de bebida alcoólica (1.01, IC-1,00-1,02). Porém, foi ação protetora não ter antecedentes pessoais de cardiopatia (0.59, IC-0,48-0,73). Conclusão: Observou-se que a presença de hipertensão arterial, consumo de bebida alcoólica e de transtorno mental comum foram elevados nos indígenas da etnia Mura. Esses achados podem ser decorrentes da aproximação e convivência entre indígenas e não indígenas favorecendo mudanças culturais, especialmente de hábitos e estilos de vida, com aumento do risco de doenças crônicas não transmissíveis.
Background: The arterial hypertension has a multifactorial disorder, including unappropriated habits and lifestyle as the excessive consumption of alcoholic beverages that may increase the blood pressure. Additionally, the symptoms related to the common mental disorder may be also associated with the health status, producing even more damages to the hypertensive subjects. Thus, this study aimed to identify the association of arterial hypertension occurrence with alcoholic beverages consumption and presence of common mental disorder in Indigenous from Mura villages, who live in rural and urban zones. Casuistic and Methods: Its a cross-sectional investigation, with demographic base, conducted with 455 Mura Indigenous from Autazes, Amazon, Brazil. Through a semi-structured interview, we gathered data about sociodemographic and educational profile, lifestyle, clinical records, family antecedents. In this occasion, the Alcohol Use Disorders Identification Test (AUDIT) and the Self-Reporting Questionnaire (SRQ-20) were applied to assess respectively the alcohol consumption and the presence of common mental disorder. The blood pressure was measured with an arm automatic device, validated for this goal, being three measures taken and, from the two last of them, a mean was obtained. Furthermore, we gathered weight, height, neck circumference, waist circumference, bioimpedance, glycemia, triglycerides and cholesterol, capillary measure for the last ones. In the bivariate analysis, we analyzed the association between hypertensive persons and the both outcomes- the alcohol consumption and the presence of common mental disorder, emphasizing the issues hypertension-related issues. The Poison regression, with robust variance, was adjusted for both outcomes, with a modelling in automatized stepwise backward, being p<0,20 the entrance criteria and p<0,05 the significance level for the final model. As estimative, we used the odds ratios and their respective confidence intervals of 95%. Results: Most were females (57,8%), with mean age of 42,2(16,74) years, living with a partner (74,7%), with about four children per family, poor educational level- Illiterate/Incomplete Basic (41,1%) and income of up two minimum wages (85,0%). 26,6% of the sample had hypertension, 20,4% were smokers and 52,8% were sedentary/irregularly active. Alcohol consumption was of 40,2%, with 13,4% showed high risk for alcohol addiction, and the consumption was higher in rural area in comparison with the urban one (57,3% vs 22,2%) p<0,001. We emphasize the following aspects of alcohol abuse: feeling of guilty and remorse (45,9%); abrupt amnesia for not remembering what happened in the night that they had drunk (31,7%); feeling hurt or impaired due to the drink consumption (29,6%); concerns from relatives, friends or healthcare professionals who advised the interviewed to interrupt the consumption (51,5%). There was not association between presence and alcoholic beverages consumption (23% and 26%). Indigenous diagnosed with referred arterial hypertension drank less alcoholic beverages (14,2%vs 85,8% p=0,009), but, when they drank, they had a larger amount than those with referred hypertension [55,3(72,2) vs 33,3(62,2) grams of Ethanol p=0,008]. The common mental disorder was identified in 45,7% of the individuals, being highlighted the following items: reporting of frequent headaches (69,5%), feeling nervous, anxious or worried (66,2%), feeling sad in the last days (56,0%), sleeping badly (55,2%) and having upset stomach (42,9%). Additionally, 7.3% reported the idea of committing suicide, and 4,2% felt themselves unable to play a useful role. We verified positive association between alcoholic beverage consumption and male gender (2.72, CI-2,12-3,48); smoking (1.29, CI-1.06-1.56); and living in rural area (2.09, CI-1.61-2.72). However, the action was protective for the age (0.98, CI-0,98-0,99), intake of natural foods (0.97, CI-0,95-0,99), and absence of dyslipidemias (0.75, CI-0,62-0,9). Among those diagnosed with common mental disorder, the arterial hypertension was found in 30,3% and the alcohol consumption once a month in 22,1%. We observed a positive association of common mental disorder and: living in the urban area (1.25, CI-1,02-1,54); unknowing the antecedents for diabetes (1.56, CI-1,24-1,96); and the alcohol consumption (1.01,CI-1,00-1,02). However, the absence of personal background of heart diseases was not protective (0.59, CI-0,48-0,73). Conclusion: We observed that the presence of arterial hypertension, alcoholic beverages consumption and common mental disorder were high in the Mura ethnicity. This finding may be explained for the approach and interaction among Indigenous and non-Indigenous, which favors cultural changes, especially in habits and lifestyle, increasing the risk of non-transferable chronic diseases.

Background: Many university students experience symptoms of depression, anxiety disorders, substance use disorders or eating disorders. This thesis aimed to develop and evaluate a trait-focused internet-based prevention programme for these disorders in students. The thesis comprises of three studies. Study 1: In a cross-sectional study, 425 students were assessed on personality and mental health. A cluster analysis of indicators of mental health suggested two groups: one "high risk" group (20 per cent), who experienced symptoms of mental disorders; and the remaining students (80 per cent), who did not experience symptoms. Students at high risk showed higher trait anxiety, perfectionism and introversion/hopelessness. Study 2: To investigate challenges of student life, a mixed-methods study combined a web survey and focus groups. In the web survey, students most frequently identified social, practical and academic challenges. The focus groups confirmed these challenges and suggested that stigma and the belief that support mechanisms at university are only for students with severe problems would hinder support seeking. Study 3: Based on the findings from studies 1 and 2, a trait-focused internet-based cognitive-behavioural intervention was developed. This intervention included modules on perfectionism, low self-esteem, difficult emotions and anxiety. An active control intervention and a procedure for personalised feedback were developed. In a randomised controlled trial, the efficacy of the intervention compared to a control intervention was investigated in 1141 students, who were classified as high or low risk according to their personality. The trait-focused intervention reduced depression, anxiety and, to some extent, phobia-related avoidance and eating disorder symptoms in students at high risk. Conclusions: These findings suggest that: (a) students at high risk of developing mental disorders can be identified; (b) high risk students report higher levels of emotional and health difficulties; and (c) the mental health of these students can be improved with an intervention targeting personality risk factors.

A cross-sectional study was carried out in a low income area of Olinda, in the state of Pernambuco, Northeast Brazil, to investigate the specific links between social class and the prevalence of common mental disorders (CMD) assessed by the Self Reporting Questionnaire (SRQ-20). The analysis brought together a wide range of potential explanatory variables grouped under four headings: demographic characteristics, socioeconomic status (SES), employment and migration. Prior to adjustment, statistically significant associations were found between CMD and all SES variables (literacy, years of schooling, own occupation, income distribution, housing conditions, possession of household appliances), except housing tenure. After adjustment for all measures of SES, gender, age and marital status, CMD was more common in those with less education (X: for linear trend=10.37, df=l, p