Jair Mari

Federal University of São Paulo | UNIFESP · Departamento de Psiquiatria

The Brazilian Academy of Sciences commissioned a report on mental health to develop strategies for addressing mental health challenges in the post-pandemic world. These strategies should be evidence-based, culturally sensitive, resourceefficient, and promote equity, while being tailored to specific contexts. The report's proposals are meant for dis...

Introduction Lower adherence to antiretroviral treatment (ART) has been found among people with HIV (PWH) who have comorbid mental disorders like depression and alcohol use in Sub-Saharan African. However, there has been less exploration with regards to other mental disorders. Methods This study assessed the association of multiple mental disorder...

Purpose: The Brazilian version of the prevention program Unplugged, #Tamojunto, has had a positive effect on bullying prevention. However, the curriculum has recently been revised, owing to its negative effects on alcohol outcomes. This study evaluated the effect of the new version, #Tamojunto2.0, on bullying. For adolescents exposed to the school...

Autism spectrum disorder (ASD) is a complex neurodevelopmental condition that is characterized by patients displaying at least two out of the classical symptoms, such as impaired social communication, impaired interactions, and restricted repetitive behavior. Early parent-mediated interventions, such as video modeling for parental training, were de...

Although psychiatric symptoms and drug use are commonly associated with adolescence, the causal relationship has not been fully established. In this study, we sought to identify baseline predictors of adolescent drug use focused on psychopathology and participation in the school-based prevention program #Tamojunto 2.0. We also aimed to assess the m...

Background: Externalizing problems are commonly associated with alcohol outcomes in adolescence. Nevertheless, findings regarding internalizing problems are mixed, and fewer longitudinal studies have considered the both problems concomitantly and the role of gender. We examined the role of externalizing and internalizing problems in predicting ado...

In Mozambique, human and financial resources for public mental health services are extremely limited. Understanding the mental health needs of those seeking healthcare can inform efficient targeting of mental health services. We examined if the frequency of mental disorders in a health facility varied based on the level of specialization of such fa...

The COVID-19 pandemic mainly affected the most vulnerable individuals. Among those, patients with schizophrenia especially suffered from unexpected changes in their routines, barriers to treatment, and distress-related events. We conducted a narrative review using all available sources of information to describe the challenges faced by schizophreni...

Introduction Less adherence to antiretroviral treatment (ART) has been found among people suffering from HIV (PWH) with comorbid mental disorders like depression and alcohol use in Mozambique, a Sub-Saharan African country. However, less is explored with regards to other mental disorders. Methods This study assessed the association of multiple men...

Background Emotional Contagion Behavior (ECB), the synchronized expression of emotional symptoms among members of a group, has been observed globally. In Mozambique, there have been numerous reports of ECB in recent years. Since 2010 several girls from a secondary school in Maputo City, Mozambique exhibited ECB which involved repeated fainting spel...

Background: Young people can receive mental health care from many sources, from formal and informal sectors. Caregiver characteristics/experiences/beliefs may influence whether young people get help and the type of care or support used by their child. We investigate facilitators/barriers to receiving formal and/or informal care, particularly those...

In this study, we aimed to describe the patterns of alcohol consumption in Brazilian adults by sociodemographic characteristics and states according to sex. Cross-sectional study including 87,555 adults from the 2019 Brazilian National Health Survey who responded to a questionnaire on alcohol consumption and were classified as non-drinkers (0 g/day...

Background Psychotic disorders contribute significantly to the global disease burden by causing disability, impaired quality of life, and higher mortality in affected people compared with the general population. In rural settings, where there is limited or no access to healthcare, individuals living with psychotic disorders often seek support from...

Objective The objective of our study was to explore clinical decisions of psychiatrists regarding the management of common mental disorders in primary care (PC) in four Latin Americans countries, through the application of clinical vignettes. Methods Using a cross-sectional design, we conducted a self-administered online questionnaire survey of ps...

This study aimed to examine whether being a victim of bullying predicted body dissatisfaction and eating disorder behavior (EDB). In this study, we performed secondary analysis from a cluster randomized controlled trial among 5208 eight grade students from 73 public schools in three Brazilian cities. Data were collected in 2019 through an anonymous...

Objective São Paulo‘s Crackland is the biggest and oldest open drug use scene in Brazil, yet little is known about the profile of crack cocaine treatment-seeking individuals living in this region. The aim of this crossectional study was to describe the demographics and clinical characteristics of treatment-seeking crack users living in the Cracklan...

Background Lay Health Workers (LHW) are important providers of community mental health services and help mitigate access and treatment gaps in Africa. However, there is a paucity of knowledge about the role and performance of these workers, as well as about the extent to which the interventions delivered are culturally adapted to the African contex...

Background: The World Health Organization (WHO) has approved the 11th Revision of the International Classification of Diseases (ICD-11). A version of the ICD-11 for Mental, Behavioural and Neurodevelopmental Disorders for use in clinical settings, called the Clinical Descriptions and Diagnostic Requirements (CDDR), has also been developed. The CDD...

Background: Smoked cocaine (i.e., crack use) is a severe health problem in Brazil, with the country being reported as having the largest crack market in the world. The objective of this study was to evaluate the effectiveness of incorporating Contingency Management targeting cocaine abstinence into a public treatment program in Brazil. Methods: Sin...

Background: Psychotic disorders contribute significantly to the global disease burden by causing disability, impaired quality of life, and higher mortality in affected people compared with the general population. In rural settings, where there is limited or no access to healthcare, individuals living with psychotic disorders often seek support from...

São Paulo’s Crackland is the biggest and oldest open drug use scene in Brazil, yet little is known about the profile of crack cocaine treatment-seeking individuals living in this region. The aim of this cross-sectional study was to describe the demographics and clinical characteristics of treatment-seeking crack users living in the Crackland region...

Objective: To describe the translation and adaptation of the Mental Illness Clinicians' Attitudes Scale version 4 (MICA v4) to Spanish and Portuguese. Methods: The questionnaire was administered to primary care physicians (PCPs) from four Latin-American countries, Brazil, Bolivia, Chile and Cuba. The validation process included four phases: 1) t...

Background We examined the association between childhood poverty and mental health disorders (MHD) in childhood and early adulthood. We also investigated whether the association between poverty in childhood and MHD is mediated by exposure to stressful life events (SLE). Methods We used data from a prospective community cohort of young people asses...

Aims Mental health problems early in life can negatively impact educational attainment, which in turn have negative long-term effects on health, social and economic opportunities. Our aims were to: (i) estimate the impacts of different types of psychiatric conditions on educational outcomes and (ii) to estimate the proportion of adverse educational...

Psychopathology is associated with impaired learning and early termination of schooling, whereas positive attributes are associated with better educational outcomes. However, it is important to understand if and how psychopathology and positive attributes longitudinally impact each other so we could shed light on where to intervene to promote educa...

Although Autism Spectrum Disorders (ASD) is recognized as being heavily influenced by genetic factors, the role of epigenetic and environmental factors is still being established. This study aimed to identify ASD vulnerability components based on familial history and intrauterine environmental stress exposure, explore possible vulnerability subgrou...

Abstract Background: Smoked cocaine (i.e., crack use) is a severe health problem in Brazil, with the country being reported as having the largest crack market in the world. The objective of this study was to evaluate the effectiveness of incorporating Contingency Management targeting cocaine abstinence into a public treatment program in Brazil. Met...

Background: We report results of an internet-based field study evaluating the diagnostic guidelines for ICD-11 mood disorders. Accuracy of clinicians' diagnostic judgments applying draft ICD-11 as compared to the ICD-10 guidelines to standardized case vignettes was assessed as well as perceived clinical utility. Methods: 1357 clinician members o...

Psychotic experiences (PE) are forms of hallucinations and delusions neither reaching the intensity and functional impairment required to be regarded as full psychotic symptoms nor a psychotic disorder. Here we investigated the ability to predict PE using multiple models (regressions, mediation and moderation) using polygenic risk score for psychot...

Early interventions benefit the mental health, academic performance and productivity of children and adolescents throughout their life. The present study protocol will evaluate the effectiveness of the Elos 2.0 Programme, which is a version adapted for Brazil by the Ministry of Health, in reducing problem behaviours (e.g., disruptiveness, aggressiv...

Psychotic-like Experiences (PE) in early adolescence may increase the risk for later psychotic and non-psychotic disorders. Common psychiatric disorders may also increase the risk of PE later in life. We aim to explore bidirectional associations of PE and common mental disorders among 1,712 youth from a 3-year follow-up community-based study. At ba...

Introduction: Most children/adolescents with disability live in low and middle-income countries and, worldwide, they are more likely to have mental health problems and achieve worse academic performance compared to those with typical development. Objective: To assess whether Brazilian children/adolescents with four types of disabilities are more...

Background: School-based prevention programs have been implemented worldwide with the intention of reducing or delaying the onset of alcohol and drug use among adolescents. However, their effects need to be evaluated, being essential to use validated and reliable questionnaires for this purpose. This study aimed to verify the semantic validity and...

Background National Health Service use the Community Mental Health Service User Questionnaire (NHS-CMH) to assess care quality. However, its reliability and internal validity is uncertain. Aims To test the NHS-CMH structure, reliability and item-level characteristics. Methods We used data from 11,373 participants who answered the 2017 NHS-CMH sur...

Homeless substance users are particularly hard to treat. In this pilot study, we evaluated the acceptability and feasibility of incorporating Contingency Management (CM) into a public Abstinent-Contingent Housing (ACH) treatment program developed to treat currently homeless crack cocaine users. A total of 21 homeless crack cocaine users were random...

Introduction: Exposure to peer aggression (PA) and bullying victimization (BV) are both expressions of peer victimization. Objectives: In four age-sex groups, (1) Can exposure to PA and BV be considered distinct experiences?; (2) In what extent adolescents exposed to PA consider themselves bullying victims?; (3) What is the effect of the number...

Several stressors associated with the coronavirus disease 2019 (COVID-19) are expected to affect the mental health of global populations: the effects of physical distancing, quarantine, and social isolation; the emotional suffering of health and other frontline workers; neuropsychiatric sequelae in those affected by the virus; the impact to familie...

Homeless substance users are particularly hard to treat. In this pilot study, we evaluated the acceptability and feasibility of incorporating Contingency Management (CM) into a public Abstinent-Contingent Housing (ACH) treatment program developed to treat currently homeless crack cocaine users. A total of 21 homeless crack cocaine users were random...

New paper about Disability and Child Mental health - a multicenter Brazilian study

Objective Subjective well-being (SWB) is impaired in individuals with depressive disorders. The aim of this study was to assess individuals in the general population identified as having depression and compared to SWB of those with antidepressants use. Methods A household study with a probability sample (N=3744) was conducted in São Paulo and Rio...

Cuidadores familiares são uma população vulnerável, com níveis elevados de estresse crônico e baixa qualidade de vida. Com base em estudos anteriores relacionando a prática regular de mindfulness (atenção plena) a benefícios para a promoção da saúde, os autores deste artigo ofereceram um programa de treinamento em atenção plena para cuidadoras de p...

Background: Mental health conditions impose a major burden worldwide, especially in low- and middle-income countries (LMICs), where health specialists are scarce. A challenge to closing LMICs' mental health treatment gap is determining the most cost-effective task-shifting pathway for delivering mental health services using evidence-based interven...

Objective This study's main purpose is to evaluate factors associated with eating disorder (ED) symptoms among Brazilian adolescents. Method The sample consisted of 5,213 students, mean age 13.24 (SD ±0.01), in the eighth grade of 93 public schools from three Brazilian cities. Data were collected through an anonymous self‐report questionnaire, ass...

Background: Epilepsy is the most common neurological disease in the world, affecting 50 million people, with the majority living in low- and middle-income countries (LMICs). A major focus of epilepsy treatment in LMICs has focused on task-sharing identification and epilepsy care by community health workers (CHWs). The present study aimed to assess...

Objective It is unclear if pediatric executive dysfunction, assessed only with cognitive-tasks, predicts clinically-relevant outcomes independently of psychiatric diagnoses. This study tests the stability and validity of a task-based classification of executive function. Method A total of 2207 individuals (6-17 years old) from the Brazilian High-R...

Aims The study aimed to evaluate the effectiveness of the government school‐based programme #Tamojunto2.0, the third Brazilian version of the European drug prevention programme, Unplugged, in preventing the use of alcohol and other drugs. Design A parallel, two‐arm cluster randomized controlled trial was conducted in 205 classes in 73 public schoo...

Background In Mozambique, human and financial resources for public mental health services are extremely limited. Understanding the mental health needs of those seeking healthcare can inform efficient targeting of mental health services. We examined if the frequency of mental disorders in a health facility varied based on the level of specialization...

Contingency Management (CM) is among the most effective behavioral interventions for cocaine use disorders, yet the dissemination of CM to community treatment settings has been limited and slow due partially to costs. Leveraging evidence-based behavioral science principles , we developed a modified version of CM termed CM Banking, designed to reduc...

Suicide among adolescents has become a major public health problem worldwide. Our study sought to describe the most commonly used methods of suicide among adolescents aged 10 to 19 years in Brazil between 2006 and 2015. Complete data were obtained from the Brazilian Health Informatics Department (DATASUS) and coded into seven categories of suicide...

Objective: Mental illness is an important public health concern, often starting early in life and particularly impacting children from low-and middle-income countries. Our aims were to 1) determine, in a representative sample of public preschool 4- to 5-year old children in Brazil, the prevalence of internalizing and externalizing disorders and soc...

Background: Depression is one of the leading causes of disability in Mozambique; however, few patients with depression are identified in primary care. To our knowledge, there are no validated tools for depression screening in Mozambique. The aim of this study was to validate the Patient Health Questionnaire-9 (PHQ-9) for use in primary care settin...

Background: Our previous studies showed increased angiotensin I-converting enzyme (ACE) activity in chronic schizophrenia (SCZ) patients compared to healthy control (HC) volunteers, and the relevance of combining ACE genotype and activity for predicting SCZ was suggested. Methods: ACE activity was measured in plasma of ACE insertion/deletion (I/...

Introduction and objectives The impact of multiple subcutaneous (s.c.) esketamine injections on the blood pressure (BP) and heart rate (HR) of patients with unipolar and bipolar treatment-resistant depression (TRD) is poorly understood. This study aimed to assess the cardiovascular safety of multiple s.c. doses of esketamine in patients with TRD....

Background Poor eye contact and joint attention are early signs of autism spectrum disorder (ASD) and important prerequisites for developing other socio‐communicative skills. Teaching parents evidence‐based techniques to improve these skills can impact the overall functioning of children with ASD. We aimed to analyse the impact of conducting a grou...

Objectives: To translate and validate the Reported and Intended Behaviour Scale (RIBS) into Brazilian Portuguese. Methods: A native Brazilian speaker fluent in English translated the RIBS into Brazilian Portuguese. Comprehensibility and face validity were assessed through discussions with mental health professionals and volunteers recruited from th...

Objective: Antidepressant use is increasing worldwide, but national data on psychotropic drug use by depressed patients in Brazil is lacking. Methodology: Between 2013 and 2014, a representative sample of urban adult individuals were asked if they had a diagnosis of chronic disease, had a medical indication for drug treatment, and were taking chro...

Background: Depression is one of the leading causes of disability in Mozambique; however, few patients with depression are identified in primary care. To our knowledge, there are no validated tools for depression screening in Mozambique. The aim of this study was to validate the Patient Health Questionnaire-9 (PHQ-9) for use in primary care setting...

Background: Epilepsy is the most common neurological disease in the world, affecting 50 million people, with the majority living in low- and middle-income countries (LMICs). A major focus of epilepsy treatment in LMICs has focused on task-sharing identification and epilepsy care by community health workers (CHWs). The present study aimed to assess...

Objective To investigate the association between exposure to domestic violence and increased risk of internalizing and externalizing problems and substance use among adolescents living with relatives with substance use disorder (SUD) at a low-income community of São Paulo, Brazil. Methods A cross-sectional study was conducted with 102 adolescents...

Background: Crack use is a severe health problem in Brazil, the country being reported among the largest crack markets in the world. Located in downtown São Paulo, Crackland emerges as a public space where thousands of crack users living under extremely vulnerable conditions consume crack openly in the streets. Aims:This pilot study evaluated the...

Objective: Population neuroscience is an emerging field that combines epidemiology and neuroscience to study how genes and the environment shape typical and atypical brain functioning. The objective of this study was to review key studies on population neuroscience from low- and middle-income countries (LMICs) and to identify potential gaps vis-à-v...

We aimed to identify blood gene expression patterns associated to psychopathological trajectories retrieved from a large community, focusing on the emergence and remission of general psychiatric symptoms. Hundred and three individuals from the Brazilian High-Risk Cohort Study (BHRCS) for mental disorders were classified in four groups according to...

Background: Autism spectrum disorder (ASD) is characterized as a neurodevelopmental disorder with stereotyped and repetitive behaviors. Dance practice can elicit esthesia to stimulate the communication process through the notion of the phenomenal body that is recognized in an expressive and symbolic space. Objective: To conduct a systematic revi...

Few studies investigate temperament interactions and its association with education in young adolescents. Here we examine a sample of 1540 adolescents (9–14 years of age, 733 females) from a community-based study in Brazil. Temperament was derived from adolescents' reports to the Early Adolescence Temperament Questionnaire. Educational outcomes wer...

Background: Depression is one of the leading causes of disability in Mozambique; however, few patients with depression are identified in primary care. To our knowledge, there are no validated tools for depression screening in Mozambique. The aim of this study was to validate the Patient Health Questionnaire-9 (PHQ-9) for use in primary care setting...

The study of patients with schizophrenia (SZ) at different clinical stages may help clarify what effects could be due to the disease itself, to the pharmacological treatment, or to the disease progression. We compared expression levels of targeted genes in blood from individuals in different stages of SZ: clinical high risk for psychosis (CHR), fir...