Publications (26)135.62 Total impact
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Dataset: The Impact of Epidemic Violence on the Prevalence of Psychiatric Disorders in Sao Paulo and Rio de Janeiro, Brazil
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ABSTRACT: Background: Violence and other traumatic events, as well as psychiatric disorders are frequent in developing countries, but there are few population studies to show the actual impact of traumatic events in the psychiatric morbidity in low and middle-income countries (LMIC). -
Article: Authors' reply.
The British journal of psychiatry: the journal of mental science 03/2013; 202(3):238. · 6.62 Impact Factor -
Article: Does childhood adversity account for poorer mental and physical health in second-generation Irish people living in Britain? Birth cohort study from Britain (NCDS).
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ABSTRACT: Worldwide, the Irish diaspora experience elevated mortality and morbidity across generations, not accounted for through socioeconomic position. The main objective of the present study was to assess if childhood disadvantage accounts for poorer mental and physical health in adulthood, in second-generation Irish people. Analysis of prospectively collected birth cohort data, with participants followed to midlife. England, Scotland and Wales. Approximately 17 000 babies born in a single week in 1958. Six per cent of the cohort were of second-generation Irish descent. Primary outcomes were common mental disorders assessed at age 44/45 and self-rated health at age 42. Secondary outcomes were those assessed at ages 23 and 33. Relative to the rest of the cohort, second-generation Irish children grew up in marked material and social disadvantage, which tracked into early adulthood. By midlife, parity was reached between second-generation Irish cohort members and the rest of the sample on most disadvantage indicators. At age 23, Irish cohort members were more likely to screen positive for common mental disorders (OR 1.44; 95% CI 1.06 to 1.94). This had reduced slightly by midlife (OR 1.27; 95% CI 0.96 to 1.69). Although at age 23 second-generation cohort members were just as likely to report poorer self-rated health (OR 1.06; 95% CI 0.79 to 1.43), by midlife this difference had increased (OR 1.25; 95% CI 0.98 to 1.60). Adjustment for childhood and early adulthood adversity fully attenuated differences in adult health disadvantages. Social and material disadvantage experienced in childhood continues to have long-range adverse effects on physical and mental health at midlife, in second-generation Irish cohort members. This suggests important mechanisms over the life-course, which may have important policy implications in the settlement of migrant families.BMJ open. 01/2013; 3(3). -
Article: The impact of epidemic violence on the prevalence of psychiatric disorders in sao paulo and rio de janeiro, Brazil.
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ABSTRACT: Violence and other traumatic events, as well as psychiatric disorders are frequent in developing countries, but there are few population studies to show the actual impact of traumatic events in the psychiatric morbidity in low and middle-income countries (LMIC). To study the relationship between traumatic events and prevalence of mental disorders in São Paulo and Rio de Janeiro, Brazil. Cross-sectional survey carried out in 2007-2008 with a probabilistic representative sample of 15- to 75-year-old residents in Sao Paulo and Rio de Janeiro, Brazil, using the Composite International Diagnostic Interview. The sample comprised 3744 interviews. Nearly 90% of participants faced lifetime traumatic events. Lifetime prevalence of any disorders was 44% in Sao Paulo and 42.1% in Rio de Janeiro. One-year estimates were 32.5% and 31.2%. One-year prevalence of traumatic events was higher in Rio de Janeiro than Sao Paulo (35.1 vs. 21.7; p<0.001). Participants from Rio de Janeiro were less likely to have alcohol dependence (OR = 0.55; p = 0.027), depression (OR = 0.6; p = 0.006) generalized anxiety (OR = 0.59; p = 0.021) and post-traumatic stress disorder (OR = 0.62; p = 0.027). Traumatic events correlated with all diagnoses - e.g. assaultive violence with alcohol dependence (OR = 5.7; p<0.001) and with depression (OR = 1.7; p = 0.001). Our findings show that psychiatric disorders and traumatic events, especially violence, are extremely common in Sao Paulo and Rio de Janeiro, supporting the idea that neuropsychiatric disorders and external causes have become a major public health priority, as they are amongst the leading causes of burden of disease in low and middle-income countries. The comparison between the two cities regarding patterns of violence and psychiatric morbidity suggests that environmental factors may buffer the negative impacts of traumatic events. Identifying such factors might guide the implementation of interventions to improve mental health and quality of life in LMIC urban centers.PLoS ONE 01/2013; 8(5):e63545. · 4.09 Impact Factor -
Article: Ethnic density as a buffer for psychotic experiences: findings from a national survey (EMPIRIC).
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ABSTRACT: Aetiological mechanisms underlying ethnic density associations with psychosis remain unclear. To assess potential mechanisms underlying the observation that minority ethnic groups experience an increased risk of psychosis when living in neighbourhoods of lower own-group density. Multilevel analysis of nationally representative community-level data (from the Ethnic Minorities Psychiatric Illness Rates in the Community survey), which included the main minority ethnic groups living in England, and a White British group. Structured instruments assessed discrimination, chronic strains and social support. The Psychosis Screening Questionnaire ascertained psychotic experiences. For every ten percentage point reduction in own-group density, the relative odds of reporting psychotic experiences increased 1.07 times (95% CI 1.01-1.14, P = 0.03 (trend)) for the total minority ethnic sample. In general, people living in areas of lower own-group density experienced greater social adversity that was in turn associated with reporting psychotic experiences. People resident in neighbourhoods of higher own-group density experience 'buffering' effects from the social risk factors for psychosis.The British journal of psychiatry: the journal of mental science 07/2012; 201:282-90. · 6.62 Impact Factor -
Article: Dementia incidence and mortality in middle-income countries, and associations with indicators of cognitive reserve: a 10/66 Dementia Research Group population-based cohort study.
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ABSTRACT: Results of the few cohort studies from countries with low incomes or middle incomes suggest a lower incidence of dementia than in high-income countries. We assessed incidence of dementia according to criteria from the 10/66 Dementia Research Group and Diagnostic and Statistical Manual of Mental Disorders (DSM) IV, the effect of dementia at baseline on mortality, and the independent effects of age, sex, socioeconomic position, and indicators of cognitive reserve. We did a population-based cohort study of all people aged 65 years and older living in urban sites in Cuba, the Dominican Republic, and Venezuela, and rural and urban sites in Peru, Mexico, and China, with ascertainment of incident 10/66 and DSM-IV dementia 3-5 years after cohort inception. We used questionnaires to obtain information about age in years, sex, educational level, literacy, occupational attainment, and number of household assets. We obtained information about mortality from all sites. For participants who had died, we interviewed a friend or relative to ascertain the likelihood that they had dementia before death. 12,887 participants were interviewed at baseline. 11,718 were free of dementia, of whom 8137 (69%) were reinterviewed, contributing 34,718 person-years of follow-up. Incidence for 10/66 dementia varied between 18·2 and 30·4 per 1000 person-years, and were 1·4-2·7 times higher than were those for DSM-IV dementia (9·9-15·7 per 1000 person-years). Mortality hazards were 1·56-5·69 times higher in individuals with dementia at baseline than in those who were dementia-free. Informant reports suggested a high incidence of dementia before death; overall incidence might be 4-19% higher if these data were included. 10/66 dementia incidence was independently associated with increased age (HR 1·67; 95% CI 1·56-1·79), female sex (0·72; 0·61-0·84), and low education (0·89; 0·81-0·97), but not with occupational attainment (1·04; 0·95-1·13). Our results provide supportive evidence for the cognitive reserve hypothesis, showing that in middle-income countries as in high-income countries, education, literacy, verbal fluency, and motor sequencing confer substantial protection against the onset of dementia. Wellcome Trust Health Consequences of Population Change Programme, WHO, US Alzheimer's Association, FONACIT/ CDCH/ UCV.The Lancet 05/2012; 380(9836):50-8. · 38.28 Impact Factor -
Article: Association between sleep duration and all-cause mortality in old age: 9-year follow-up of the Bambuí Cohort Study, Brazil.
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ABSTRACT: This study investigates the association of sleep duration with risk of all-cause mortality among elderly Brazilians using data from a 9-year population-based cohort study and applying a multivariable longitudinal categorical and continuous analysis using Cox's proportional hazards models. This analysis used data from the Bambui Health and Ageing Study (BHAS), conducted in Bambuí city (approximately 15000 inhabitants) in southeastern Brazil. The study population comprised 1512 (86.8%) of all eligible 1742 elderly residents. In multivariable analysis, using sleep duration as categorical variable and controlling for multiple measures of sociodemographic and health status, those who slept 9h or more per night were found to be at higher risk of mortality than those who slept 7h [hazard ratio (HR): 1.53; 95% confidence interval (CI): 1.12-2.09]. Excluding those whose deaths occurred within 2years after entry, this association remained significant (HR: 1.56; 95% CI: 1.12-2.18). In analyses using sleep duration as a continuous variable, a linear correlation was found between sleep duration and mortality in all adjusted models in the whole sample (HR: 1.08; 95% CI: 1.02-1.15) and following exclusion of those whose deaths occurred within 2years after entry (HR: 1.13; 95% CI: 1.06-1.21). Both linear and quadratic terms were significant, reflecting a predicted relationship, with mortality predominantly increasing in association with long sleep duration but with the addition of a slight decrease in association with shorter sleep duration. In conclusion, long rather than short sleep duration was associated principally with all-cause mortality in this sample. It is therefore reasonable to suggest that clinicians should be aware of the potential adverse prognosis associated with prolonged sleep.Journal of Sleep Research 06/2011; 20(2):303-10. · 3.16 Impact Factor -
Article: Leg length, skull circumference, and the prevalence of dementia in low and middle income countries: a 10/66 population-based cross sectional survey.
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ABSTRACT: Adult leg length is influenced by nutrition in the first few years of life. Adult head circumference is an indicator of brain growth. There is a limited literature linking short legs and small skulls to an increased risk for cognitive impairment and dementia in late life. One phase cross-sectional surveys were carried out of all residents aged over 65 years in 11 catchment areas in China, India, Cuba, Dominican Republic, Venezuela, Mexico and Peru (n = 14,960). The cross-culturally validated 10/66 dementia diagnosis, and a sociodemographic and risk factor questionnaire were administered to all participants, and anthropometric measures taken. Poisson regression was used to calculate prevalence ratios for the effect of leg length and skull circumference upon 10/66 dementia, controlling for age, gender, education and family history of dementia. The pooled meta-analyzed fixed effect for leg length (highest vs. lowest quarter) was 0.82 (95% CI, 0.68-0.98) and for skull circumference 0.75 (95% CI, 0.63-0.89). While point estimates varied between sites, the proportion of the variability attributable to heterogeneity between studies as opposed to sampling error (I2) was 0% for leg length and 22% for skull circumference. The effects were independent and not mediated by family history of dementia. The effect of skull circumference was not modified by educational level or gender, and the effect of leg length was not modified by gender. Since leg length and skull circumference are said to remain stable throughout adulthood into old age, reverse causality is an unlikely explanation for the findings. Early life nutritional programming, as well as neurodevelopment may protect against neurodegeneration.International Psychogeriatrics 03/2011; 23(2):202-13. · 2.24 Impact Factor -
Article: Leg length, skull circumference, and the prevalence of dementia in low and middle income countries: a 10/66 population-based cross sectional survey
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ABSTRACT: Background: Adult leg length is influenced by nutrition in the first few years of life. Adult head circumference is an indicator of brain growth. There is a limited literature linking short legs and small skulls to an increased risk for cognitive impairment and dementia in late life.Methods: One phase cross-sectional surveys were carried out of all residents aged over 65 years in 11 catchment areas in China, India, Cuba, Dominican Republic, Venezuela, Mexico and Peru (n = 14,960). The cross-culturally validated 10/66 dementia diagnosis, and a sociodemographic and risk factor questionnaire were administered to all participants, and anthropometric measures taken. Poisson regression was used to calculate prevalence ratios for the effect of leg length and skull circumference upon 10/66 dementia, controlling for age, gender, education and family history of dementia.Results: The pooled meta-analyzed fixed effect for leg length (highest vs. lowest quarter) was 0.82 (95% CI, 0.68–0.98) and for skull circumference 0.75 (95% CI, 0.63–0.89). While point estimates varied between sites, the proportion of the variability attributable to heterogeneity between studies as opposed to sampling error (I2) was 0% for leg length and 22% for skull circumference. The effects were independent and not mediated by family history of dementia. The effect of skull circumference was not modified by educational level or gender, and the effect of leg length was not modified by gender.Conclusions: Since leg length and skull circumference are said to remain stable throughout adulthood into old age, reverse causality is an unlikely explanation for the findings. Early life nutritional programming, as well as neurodevelopment may protect against neurodegeneration.International Psychogeriatrics 02/2011; 23(02):202 - 213. · 2.24 Impact Factor -
Article: Trajectories of cognitive decline over 10 years in a Brazilian elderly population: the Bambuí Cohort Study of Aging.
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ABSTRACT: Few population-based studies have examined long term cognitive trajectory, and these studies were conducted in high income countries. We investigated the association of age, gender and education with 10-year cognitive trajectory in a well-defined population of elderly using data from the Bambuí Cohort Study of Aging, in Brazil. Cognition was measured using the Mini- Mental State Examination (MMSE). Cohort members underwent annual follow-ups. This analysis was based on 12,206 MMSE measurements from 1,461 (91%) baseline participants. We used mixed effects models to study MMSE as outcome. The key findings from this analysis are that women and people with a higher schooling level at baseline had high scores of MMSE, while older participants started off lower. Regarding cognitive decline, women, older people and those with a higher schooling level declined faster.Cadernos de saúde pública / Ministério da Saúde, Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública 01/2011; 27 Suppl 3:S345-50. · 0.83 Impact Factor -
Article: Measuring disability across cultures--the psychometric properties of the WHODAS II in older people from seven low- and middle-income countries. The 10/66 Dementia Research Group population-based survey.
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ABSTRACT: We evaluated the psychometric properties of the 12-item interviewer-administered screener version of the World Health Organization Disability Assessment Schedule-version II (WHODAS II) among older people living in seven low- and middle-income countries. Principal component analysis (PCA), confirmatory factor analysis (CFA) and Mokken analyses were carried out to test for unidimensionality, hierarchical structure, and measurement invariance across 10/66 Dementia Research Group sites. PCA generated a one-factor solution in most sites. In CFA, the two-factor solution generated in Dominican Republic fitted better for all sites other than rural China. The two factors were not easily interpretable, and may have been an artefact of differing item difficulties. Strong internal consistency and high factor loadings for the one-factor solution supported unidimensionality. Furthermore, the WHODAS II was found to be a 'strong' Mokken scale. Measurement invariance was supported by the similarity of factor loadings across sites, and by the high between-site correlations in item difficulties. The Mokken results strongly support that the WHODAS II 12-item screener is a unidimensional and hierarchical scale confirming to item response theory (IRT) principles, at least at the monotone homogeneity model level. More work is needed to assess the generalizability of our findings to different populations.International journal of methods in psychiatric research. 03/2010; 19(1):1-17. -
Article: Measuring disability across cultures — the psychometric properties of the WHODAS II in older people from seven low‐ and middle‐income countries. The 10/66 Dementia Research Group population‐based survey
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ABSTRACT: We evaluated the psychometric properties of the 12-item interviewer-administered screener version of the World Health Organization Disability Assessment Schedule – version II (WHODAS II) among older people living in seven low- and middle-income countries. Principal component analysis (PCA), confirmatory factor analysis (CFA) and Mokken analyses were carried out to test for unidimensionality, hierarchical structure, and measurement invariance across 10/66 Dementia Research Group sites.PCA generated a one-factor solution in most sites. In CFA, the two-factor solution generated in Dominican Republic fitted better for all sites other than rural China. The two factors were not easily interpretable, and may have been an artefact of differing item difficulties. Strong internal consistency and high factor loadings for the one-factor solution supported unidimensionality. Furthermore, the WHODAS II was found to be a ‘strong’ Mokken scale. Measurement invariance was supported by the similarity of factor loadings across sites, and by the high between-site correlations in item difficulties.The Mokken results strongly support that the WHODAS II 12-item screener is a unidimensional and hierarchical scale confirming to item response theory (IRT) principles, at least at the monotone homogeneity model level. More work is needed to assess the generalizability of our findings to different populations. Copyright © 2010 John Wiley & Sons, Ltd.International Journal of Methods in Psychiatric Research. 01/2010; 19(1):1 - 17. -
Article: Understanding the effect of ethnic density on mental health: multi-level investigation of survey data from England.
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ABSTRACT: To determine if living in areas where higher proportions of people of the same ethnicity reside is protective for common mental disorders, and associated with a reduced exposure to discrimination and improved social support. Finally, to determine if any protective ethnic density effects are mediated by reduced exposure to racism and improved social support. Multi-level logistic regression analysis of national survey data, with area-level, own-group ethnic density modelled as the main exposure. Participants and setting 4281 participants of Irish, black Caribbean, Indian, Pakistani, Bangladeshi, and white British ethnicity, aged 16-74 years, randomly sampled from 892 "middle layer super output areas" in England. Common mental disorders (assessed via structured interviews); discrimination (assessed via structured questionnaire); and social support and social networks (assessed via structured questionnaire). Although the most ethnically dense areas were also the poorest, for each 10 percentage point increase in own-group ethnic density, there was evidence of a decreased risk of common mental disorders, for the full ethnic minority sample (odds ratio 0.94 (95% confidence interval 0.89 to 0.99); P=0.02, trend), for the Irish group (odds ratio 0.21 (0.06 to 0.74); P=0.01, trend), and for the Bangladeshi group (odds ratio 0.75 (0.62 to 0.91); P=0.005, trend), after adjusting for a priori confounders. For some groups, living in areas of higher own-group density was associated with a reduction in the reporting of discrimination and with improved social support and improved social networks. However, none of these factors mediated ethnic density effects. A protective effect of living in areas of higher own-group ethnic density was present for common mental disorders for some minority groups. People living in areas of higher own-group density may report improved social support and less discrimination, but these associations did not fully account for density effects.BMJ (Clinical research ed.). 01/2010; 341:c5367. -
Article: Dimensions underlying the mini-mental state examination in a sample with low-education levels: the Bambuí health and aging study.
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ABSTRACT: To investigate the validity of previously suggested dimensions underlying the Mini-Mental State Examination (MMSE) and differences in associations of these dimensions with sociodemographic and health characteristics in an older Latin-American community sample with low levels of education. Secondary analysis of baseline data from a population-based cohort study. Bambuí, Brazil. Of 1,742 total residents aged 60 years or older, 1,558 (89.4%) participated at this study. A standard Brazilian version of the MMSE. A five-factor solution (Concentration, Language/Praxis, Orientation, Attention, and Memory) for the MMSE was generated from Principal Components Analysis, and the five-factor solutions proposed in previous studies of developed nation samples were tested in this sample by Confirmatory Factor Analysis. In the adjusted linear regression models, MMSE factors varied in their correlates: for example, female gender was associated with higher concentration, orientation, and attention but lower Language/Praxis; increased age was inversely associated only with language and attention; and activity of daily living impairment was principally associated with lower Language/Praxis. This study provides support for the cross-sectional equivalence of the MMSE, suggesting that most of the items and underlying constructs remain meaningful after alteration and translation in a low-education sample with lower overall distribution of scores.The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry 10/2009; 17(10):863-72. · 3.35 Impact Factor -
Article: Depression and parkinsonism in older Europeans: results from the EURODEP concerted action.
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ABSTRACT: The prevalence rate of depression among patients with Parkinson's disease (PD) has been estimated at 25%, although prevalence figures range between 7-76%. Relatively few studies on PD and depression are based on random samples in the general population. Some depressive symptoms can also be understood as symptoms of parkinsonism, and the current study aims to describe which 'overlap' symptoms can be identified in a community sample. Data are employed from the EURODEP collaboration. Nine study centres, from eight western European countries, provided data on depression (most GMS-AGECAT), depressive symptoms (EURO-D items and anxiety), parkinsonism (self-report of PD or clinical signs of PD), functional disability and dementia diagnosis. Data were complete for 16 313 respondents, aged 65 and older; 306 (1.9%) reported or had signs of parkinsonism. The rate of depression was about twice as high among respondents with parkinsonism (unadjusted Odds Ratio 2.44, 95% Confidence Interval 1.88-3.17), also among those without functional disability. 'Overlap' symptoms between parkinsonism and depression, were represented by motivation and concentration problems, appetite problems and especially the symptom of fatigue (energy loss). However, principal component analysis showed that these 'overlap' symptoms loaded on different factors of the EURO-D scale. As among clinical patients with PD, depression is highly common in community dwelling older people with parkinsonism, even among those without functional disability. Although fatigue did not strongly relate to motivational symptoms, both types of 'overlap' symptoms possibly trigger a final common pathway towards a full depressive syndrome.International Journal of Geriatric Psychiatry 10/2009; 25(7):679-87. · 2.42 Impact Factor -
Article: Violence and post-traumatic stress disorder in Sao Paulo and Rio de Janeiro, Brazil: the protocol for an epidemiological and genetic survey.
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ABSTRACT: BACKGROUND: violence is a public health major concern, and it is associated with post-traumatic stress disorder and other psychiatric outcomes. Brazil is one of the most violent countries in the world, and has an extreme social inequality. Research on the association between violence and mental health may support public health policy and thus reduce the burden of disease attributable to violence. The main objectives of this project were: to study the association between violence and mental disorders in the Brazilian population; to estimate the prevalence rates of exposure to violence, post-traumatic stress disorder, common metal disorder, and alcohol hazardous use and dependence: and to identify contextual and individual factors, including genetic factors, associated with the outcomes. METHODS/DESIGN: one phase cross-sectional survey carried out in Sao Paulo and Rio de Janeiro, Brazil. A multistage probability to size sampling scheme was performed in order to select the participants (3000 and 1500 respectively). The cities were stratified according to homicide rates, and in Sao Paulo the three most violent strata were oversampled. The measurements included exposure to traumatic events, psychiatric diagnoses (CIDI 2.1), contextual (homicide rates and social indicators), and individual factors, such as demographics, social capital, resilience, help seeking behaviours. The interviews were carried between June/2007 February/2008, by a team of lay interviewers. The statistical analyses will be weight-adjusted in order to take account of the design effects. Standardization will be used in order to compare the results between the two centres. Whole genome association analysis will be performed on the 1 million SNP (single nucleotide polymorphism) arrays, and additional association analysis will be performed on additional phenotypes. The Ethical Committee of the Federal University of Sao Paulo approved the study, and participants who matched diagnostic criteria have been offered a referral to outpatient clinics at the Federal University of Sao Paulo and Federal University of Rio de Janeiro.BMC Psychiatry 02/2009; 9:34. · 2.55 Impact Factor -
Article: Prevalence of dementia in Latin America, India, and China: a population-based cross-sectional survey.
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ABSTRACT: Studies have suggested that the prevalence of dementia is lower in developing than in developed regions. We investigated the prevalence and severity of dementia in sites in low-income and middle-income countries according to two definitions of dementia diagnosis. We undertook one-phase cross-sectional surveys of all residents aged 65 years and older (n=14 960) in 11 sites in seven low-income and middle-income countries (China, India, Cuba, Dominican Republic, Venezuela, Mexico, and Peru). Dementia diagnosis was made according to the culturally and educationally sensitive 10/66 dementia diagnostic algorithm, which had been prevalidated in 25 Latin American, Asian, and African centres; and by computerised application of the dementia criterion from the Diagnostic and Statistical Manual of Mental Disorders (DSM IV). We also compared prevalence of DSM-IV dementia in each of the study sites with that from estimates in European studies. The prevalence of DSM-IV dementia varied widely, from 0.3% (95% CI 0.1-0.5) in rural India to 6.3% (5.0-7.7) in Cuba. After standardisation for age and sex, DSM-IV prevalence in urban Latin American sites was four-fifths of that in Europe (standardised morbidity ratio 80 [95% CI 70-91]), but in China the prevalence was only half (56 [32-91] in rural China), and in India and rural Latin America a quarter or less of the European prevalence (18 [5-34] in rural India). 10/66 dementia prevalence was higher than that of DSM-IV dementia, and more consistent across sites, varying between 5.6% (95% CI 4.2-7.0) in rural China and 11.7% (10.3-13.1) in the Dominican Republic. The validity of the 847 of 1345 cases of 10/66 dementia not confirmed by DSM-IV was supported by high levels of associated disability (mean WHO Disability Assessment Schedule II score 33.7 [SD 28.6]). As compared with the 10/66 dementia algorithm, the DSM-IV dementia criterion might underestimate dementia prevalence, especially in regions with low awareness of this emerging public-health problem.The Lancet 08/2008; 372(9637):464-74. · 38.28 Impact Factor -
Article: Public health significance of mixed anxiety and depression: beyond current classification.
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ABSTRACT: The public health significance of mixed anxiety-depressive disorder (MADD) and the distinctiveness of its phenomenology have yet to be established. To determine the public health significance of MADD, and to compare its phenomenology with ICD-10 anxiety, depressive, and comorbid anxiety and depressive disorders. Weighted analysis of data from the Great Britain National Psychiatric Morbidity survey was conducted with a representative household sample of 8580 persons aged 16-74 years. The 1-month prevalence of MADD was 8.8%. A fifth of all days off work in Britain occurred in this group. The symptom profile of MADD was similar to 'pure' ICD-10 anxiety and depression, but with a lower overall symptom count. The disorder was associated with significant impairment of health-related quality of life. Differences in health-related quality of life measures between diagnostic groups were accounted for by overall symptom severity, which remained strongly associated with health-related quality of life measures after adjusting for diagnostic group. The finding that half of the anxiety, depression and MADD cases and a third of the comorbid depression and anxiety cases grouped into a single latent class challenges the notion of these conditions as having distinct phenomenologies. Mixed presentations may be the norm in the population. The data support the pathological significance of MADD in its negative impact upon population health. Dimensional approaches to classification may provide a more parsimonious description of anxiety and depressive disorders compared with categorical approaches.The British Journal of Psychiatry 04/2008; 192(3):171-7. · 6.62 Impact Factor -
Article: Co-occurrence of chronic physical pain and psychiatric morbidity in a community sample of older people.
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ABSTRACT: Knowledge about co-occurrence of the most frequent chronic pain symptoms with psychiatric morbidity in older people is very limited. To study the association of psychiatric morbidity and painful physical conditions in people aged 60 years and over. Population-based random sample of 7,040 household residents, aged 60 years and over, in Brazil. The overall prevalence of pain conditions is 76%. Age-sex specific prevalence of chronic pain conditions such as back pain, joint, abdominal, chest, headaches, reported by respondents ranged from 11.6% up to 51.1%. In logistic regression models, chest pain, head pain, back pain, joint pain and abdominal pain emerged as predictors of psychiatric morbidity. The odds of psychiatric morbidity are also affected by income, ethnicity, origin (urban/rural), and marital status. The association of chronic painful conditions and psychiatric morbidity in late life is statistically strong in this surveyed population.International Journal of Geriatric Psychiatry 10/2007; 22(9):902-8. · 2.42 Impact Factor -
Article: Validation of the Spanish version of the EURO-D scale: an instrument for detecting depression in older people.
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ABSTRACT: To standardize the EURO-D scale as a method for detecting depression in Spanish older people. In a first phase, a sample of 1080 community older people was assessed with the GMS-AGECAT by lay interviewers. In a second phase, all the probable cases and a similar number of randomly selected probable non-cases were assessed using DSM-III-R diagnosis by psychiatrists. To test reliability, internal consistency with the Cronbach alpha coefficient and test-retest reliability (Kappa value) were obtained. Validity, sensitivity and specificity, predictive values, Receiver Operating Characteristic (ROC) curve, and Specific Likelihood Ratios (SSLR) were calculated. A high internal consistency was obtained in both phases of the study (alpha = 0.75; alpha = 0.79, respectively). Test-retest reliability was acceptable (weighted kappa = 0.60). For the prediction of DSM-III-R diagnosis validity coefficients (cut-off point 3/4) were: sensitivity 91.8%, specificity 76.6% and area under the ROC curve 0.92 [95% Confidence Intervals (0.89-0.95)]. Illiteracy and cognitive difficulties had a small negative effect on the performance of the scale. The EURO-D scale is a reliable and valid instrument for detecting probable cases of depression in older people in Spain. Illiteracy and cognitive difficulties should be considered when interpreting the results.International Journal of Geriatric Psychiatry 01/2007; 21(12):1199-205. · 2.42 Impact Factor
Top co-authors
Top Journals
Institutions
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2010–2013
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King's College London
- Department of Health Service and Population Research
London, ENG, United Kingdom
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2011
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Centro de Pesquisas René Rachou
Belo Horizonte, Estado de Minas Gerais, Brazil -
Federal University of Minas Gerais
- Faculdade de Medicina
Belo Horizonte, Estado de Minas Gerais, Brazil
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2009
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Fundação Oswaldo Cruz
Rio de Janeiro, Rio de Janeiro, Brazil -
VU University Amsterdam
- Department of Psychiatry
Amsterdam, North Holland, Netherlands
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2001
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Nottingham Trent University
Nottingham, ENG, United Kingdom
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1992
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University of Liverpool
Liverpool, ENG, United Kingdom
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