Marcelo Feijo Mello

• MD, PhD
• Universidade Federal de São Paulo at Federal University of São Paulo

Schizophrenia diagnostics have evolved to adapt to clinical needs and scientific advances, and the current denominations emerged at the beginning of the twentieth century. Most problems arise while integrating clinical experiences, based on historical psychopathological descriptions, with emerging translational neuroscience research. This study aim...

Background Available empirical evidence on participant-level factors associated with dropout from psychotherapies for post-traumatic stress disorder (PTSD) is both limited and inconclusive. More comprehensive understanding of the various factors that contribute to study dropout from cognitive-behavioural therapy with a trauma focus (CBT-TF) is cruc...

Insecure attachment styles have been linked to an increased risk for suicidality, functioning as a distal risk factor for suicide behaviors in adulthood. Studies on the subject are numerous, but heterogeneous in methodology. This study aimed to sensibly group study findings and quantify the magnitude of this relationship. We performed a systematic...

Objective: The confluence of conflict-, climate-, and public health-related emergencies in Mozambique increases the risk of posttraumatic stress disorder (PTSD). Few brief screening tools for PTSD have been validated in low- and middle-income countries. We aimed to validate the five-item Primary Care PTSD Screen for the Diagnostic and Statistical M...

Generalized anxiety disorder (GAD) is a highly prevalent mental disorder. Previous data indicate more than 18 million Brazilians suffer from that condition. Traditionally, GAD has been considered a mild mental health disorder, despite its close link to decrease life expectancy, cardiovascular disease, and suicide. Objective: To combine elements of...

This is the first part of two documents prepared by experts for the Brazilian S20 mental health report. These reports outline strategies aimed at addressing the exacerbated mental health challenges arising from a post-pandemic world. Ongoing psychiatric epidemiology research has yielded evidence linking mental health with intricate social determina...

Objective: Post-traumatic stress disorder (PTSD) is triggered by traumatic events, but genetic vulnerability and a history of childhood trauma are additional factors that may increase the risk of PTSD. Thus, our study focused on exploring the interaction between genetic susceptibility, as assessed by polygenic risk score (PRS), and traumatic event...

Background: During the COVID-19 pandemic, health-care workers (HCWs) may have been confronted with situations that may culminate in moral injury (MI). MI is the psychological distress that may result from perpetrating or witnessing actions that violate one’s moral codes. Literature suggests that MI can be associated with mental health problems. Ob...

Introduction Attachment patterns are established during early childhood; however, extreme experiences throughout life may change this structure, either toward attachment security or insecurity. We analyzed changes in attachment dimensions in women with acute post-traumatic stress disorder (PTSD) following sexual assault, that were randomized to a 1...

Objective: To review the literature from the last twenty years on pharmacological treatments for post-traumatic stress disorder to clarify questions about the efficacy and tolerability of pharmacotherapy and the superiority of one specific agent over another for creating a treatment guideline based on levels of evidence. Methods: Randomized clinica...

Background Tuberculosis (TB) and depression are highly comorbid and linked to higher rates of death and disability. Several evidence-based treatments for depression have been successfully implemented in low- and middle-income countries, but more knowledge is needed on how to bring these innovations to scale within complex ’real world’ public health...

BACKGROUND: Tonic immobility (TI) is a reflexive, involuntary response that causes motor inhibition, vocal suppression, and analgesia. TI is elicited by extreme fear and perception of entrapment in a life-threatening situation. Research suggests that TI is a frequent peritraumatic response and may be related to subsequent posttraumatic stress disor...

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...

Introduction: Sexual violence is one of the most severe traumatic events. It is associated with a higher risk for post-traumatic stress disorder (PTSD) development. Sleep disturbances such as insomnia are frequently reported by PTSD patients and play a key role in the development and course of the disorder. Sleep disturbances are associated with h...

Introduction: Sexual assault and a history of childhood sexual abuse (CSA) are related to posttraumatic stress disorder (PTSD) development. Long interspersed nuclear elements (LINE-1) are transposable elements, and their methylation is used to infer DNA global methylation. DNA methylation can be affected by trauma exposition which in turn would be...

Racial discrimination (RD) is unfair treatment of individuals based on race or ethnicity. It is a pervasive and increasing phenomenon in the lives of many individuals with deleterious effects on mental health. Research implicates RD in diminished well-being, lower life satisfaction and self-esteem, and mental health disorders. Furthermore, there ha...

Few studies have assessed biomarkers for the differentiation of major depressive disorder (MDD) and bipolar disorder (BD). However, some elements of depression such as hormones and receptors of the renin–angiotensin–adrenal system (RAAS), the hypothalamus–pituitary–adrenal (HPA) axis, and history of early-life stress (ELS) could be considered for d...

Sexually assaulted women represent a particularly high-risk group for developing post-traumatic stress disorder (PTSD). Potentially traumatic events (PTEs) and peritraumatic dissociation (PD) are known risk factors for PTSD. However, little is known about how previous trauma affects PD and how this relationship affects PTSD. We aimed to investigate...

Background: Sexual assault often triggers posttraumatic stress disorder (PTSD), a potentially chronic severe mental disorder. Most guidelines recommend selective serotonin reuptake inhibitors (SSRIs) and trauma-focused psychotherapies as treatment options. Interpersonal Psychotherapy (IPT), adapted for PTSD (IPT-PTSD), focuses on interpersonal cons...

Introduction Depression is the most common mental disorder among people living with HIV/AIDS and has a negative impact on HIV treatment outcomes. Training lay HIV counselors to identify and manage depression may contribute to improved patient access and adherence to treatment, and reduce stigma and discrimination among lay health workers toward bot...

Full-text is available: https://authors.elsevier.com/a/1fl2V55vZ61XC Background Sexual violence is a traumatic event that can trigger post-traumatic stress disorder (PTSD) and generate biological responses to stress characterized by inhibiting the hypothalamic-pituitary axis (HPA), altering immune activity, and changing the structure and function...

Some individuals show abnormal reactions to extreme fear and life-threatening situations, including tonic immobility (TI) and peri-traumatic dissociation (PTD). We aimed to investigate the association of TI and PTD with posttraumatic stress disorder (PTSD) in women who experienced sexual violence and the risk factors for PTD occurrence. We compared...

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...

Objective: Children of depressed mothers are at risk of developing mental health problems. We sought to determine whether treatment for maternal depression delivered by community health workers (CHW) would decrease behavioral/emotional symptoms in their child. An intervention treating maternal depressive symptoms in a low-middle-income country can...

Esta pesquisa foi desenvolvida a partir do projeto temático "Transtorno de estresse pós-traumático e neuroprogressão: trauma e estresse no aumento da carga alostática e aceleração do processo de envelhecimento", realizado com mulheres vítimas de violência sexual e que desenvolveram estresse pós-traumático no estado de São Paulo. Neste estudo, são a...

Telomeres are short tandem repeats of “TTAGGG” that protect the chromosome ends from deterioration or fusion of chromosomes. Their repeat length shortens with cell division acting as a biomarker of cellular aging. Traumatic stress events during adulthood or childhood have been associated with posttraumatic stress disorder (PTSD) and short leukocyte...

Importance: Task sharing, the training of nonspecialist workers with no formal experience in counseling, is a promising strategy for addressing the large gap in treatment for depression in low- and middle-income countries (LMICs). Objective: To examine the outcomes and moderators of task-shared psychological interventions associated with depress...

Nos últimos meses, o Brasil testemunhou uma série de catástrofes naturais causadas pelas fortes chuvas de verão. Moradores da Bahia, Minas Gerais e, por último, de Petrópolis, no Rio de Janeiro, foram vítimas desses desastres, que causaram diversos danos à vida das pessoas. Os impactos causados são enormes e vão desde prejuízos econômicos até a per...

This proof-of-concept study aimed to investigate the viability of a predictive model to support posttraumatic stress disorder (PTSD) staging. We performed a naturalistic, cross-sectional study at two Brazilian centers: the Psychological Trauma Research and Treatment (NET-Trauma) Program at Universidade Federal of Rio Grande do Sul, and the Program...

A growing body of research demonstrates the association between neighborhood context and health. The underlying biological mechanisms of this association are not fully understood. We conducted a systematic review of studies that investigated the association between neighborhood context and telomere length (TL), a DNA-protein complex that shortens a...

Objective Improved understanding of the time course of neural changes associated with adolescent PTSD would elucidate the development of the disorder and could inform approaches to treatment. We compared hippocampal volumes and resting state functional connectivity (RSFC) in adolescent girls with post-traumatic stress disorder (PTSD) secondary to s...

Estou ansioso ou com Covid? Essa e outras dúvidas têm rodado a internet desde o início da pandemia. Segundo o site de busca Google, no ano passado os brasileiros procuraram três vezes mais pelo tema ansiedade do que nos últimos 16 anos. Uma coisa é certa, a pandemia está mexendo com a saúde mental de todos. Além de provocar problemas na economia, n...

Background: The mental health impact of the COVID-19 crisis may differ from previously studied stressful events in terms of psychological reactions, specific risk factors, and symptom severity across geographic regions worldwide. Objective: To assess the impact of COVID-19 on a wide range of mental health symptoms, to identify relevant risk factors...

ABSTRACT Background: The mental health impact of the COVID-19 crisis may differ from previously studied stressful events in terms of psychological reactions, specific risk factors, and symptom severity across geographic regions worldwide.Objective: To assess the impact of COVID-19 on a wide range of mental health symptoms, to identify relevant risk...

Background: Most posttraumatic stress disorder (PTSD) sleep disturbances reports have been conducted in male combat veteran populations, usually decades after the disorder’s onset. Given the increase in the prevalence of violence against women and the fact that women are at greater risk for developing PTSD, it is critical to examine sleep abnormali...

Objectives: The aim of this study was to validate CAPS-5 for the Brazilian-Portuguese language on a sample of 128 individuals from two centers (from the cities of São Paulo and Porto Alegre) who have been recently exposed to a traumatic event. Methods: We performed a reliability analysis between interviewers (with a subset of 32 individuals), an in...

Background: Sexual assault is implicated in several adverse psychological and physical health outcomes, including posttraumatic stress disorder (PTSD) and depression. Neurobiological research has shown variations related to the hypothalamic-pituitary-adrenal (HPA) axis, immune alterations, metabolic function, and brain circuitry. Although these me...

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...

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...

Background: Posttraumatic stress disorder (PTSD) is a prevalent, chronic, and severe disorder related to traumatic events. Women are disproportionately affected by PTSD than men and are more at risk in the occurrence of sexual assault victimization. Estimates suggest that 50% of women develop PTSD following sexual assault and successful clinical ma...

A pandemia causada pela COVID-19 já é uma catástrofe mundial. Provoca uma crise sem precedentes na história contemporânea, o que também exige uma resposta de clínicos e pesquisadores em saúde mental. Neste artigo, os autores clarificam alguns conceitos do campo de trauma psíquico envolvidos nesse contexto.Em resposta ao impacto psíquico desta pande...

Discrimination is unfair treatment against a certain group based on race, age, gender, sexual orientation, or other social identities. Discrimination is pervasive in society, elevates psychosocial stress, and is associated with negative mental and physical health outcomes. However, more research is needed to understand the biological mechanisms und...

Introduction The increase in violence against young women has a high impact on the prevalence of Posttraumatic stress disorder (PTSD). The lifetime prevalence of PTSD is twice as high in women. However, most studies assessing sleep disturbances in PTSD were conducted predominantly in male samples and combat veterans. Objective: To analyze the sleep...

BACKGROUND Posttraumatic stress disorder (PTSD) is a prevalent, chronic, and severe disorder related to traumatic events. Women are disproportionately affected by PTSD than men and are more at risk in the occurrence of sexual assault victimization. Estimates suggest that 50% of women develop PTSD following sexual assault and successful clinical man...

A Covid-19 é uma pandemia que teve início no final de 2019, na China, e rapidamente se espalhou por todo o mundo causando pânico na população. Diversos países adotaram medidas de quarentena por conta do rápido contágio da doença, o que impacta diretamente na saúde mental de toda a população. Estratégias de prevenção em saúde mental precisam ser ado...

Posttraumatic stress disorder (PTSD) and acute stress disorder (ASD) are the most frequent diagnosis in the Trauma and Stressor-Related Disorders chapter of the Diagnostic and Statistical Manual of Mental Disorders-5th Edition (DSM-5). The present chapter focuses on ASD and PTSD including background, psycho- and physiopathology, diagnosis, and trea...

Background: This study investigated the patterns of comorbidity between PTSD and depression, other anxiety disorders, alcohol-related disorders using the DSM-IV and ICD-10 criteria. The temporal sequence of the comorbid diagnoses was also investigated. Methods: We used data from a large population-based survey carried out between 2007 and 2008 i...

Background An estimated 16.9% of adult Brazilian women experience sexual assault in their lifetime. Almost half of women who suffer such trauma develop post-traumatic stress disorder (PTSD). Markowitz et al. (2015) found that an affect-focused non-exposure therapy, Interpersonal Psychotherapy (IPT), adapted to treat PTSD (IPT-PTSD) had similar effi...

Resumo O Transtorno de Estresse Pós-Traumático (TEPT) é frequentemente associado a déficits cognitivos, porém ainda existem divergências com relação as funções cognitivas afetadas. O objetivo do presente estudo foi avaliar o impacto do TEPT na memória operacional, na memória visual de curto prazo, na memória episódica de longo prazo, na memória sem...

https://doi.org/10.1590/1516-4446-2018-0136

Background: While under-use of mental health services by adults with anxiety and/or depression is well established, use in a violence-prone area, and as a function of diagnosis and personality characteristics such resilience, is little known. We examine the sociodemographic and personality characteristics (specifically resilience), associated with...

Letter to explain about the validation process of Caps 5 in Portuguese.

Background Posttraumatic Stress Disorder (PTSD) is a clinical condition that occurs after experiencing a traumatic external stressful situation, such as exposure to sexual assault or rape. Previous studies suggested that PTSD may be associated with shortened Leukocyte Telomere Length (LTL), in war veterans. Telomeres are repetitive DNA sequences lo...

Objective: Much research has been published on the role of sexual revictimization in the emergence of mental disorders in adulthood, but findings have sometimes been contradictory. The present systematic review sought to assess the state of the evidence on revictimization as a potential factor for the emergence of posttraumatic stress disorder (PT...

Background: Childhood sexual abuse (CSA) is a prevalent subtype of early life stress associated with changes in immunological and neuroendocrine systems leading to inflammatory responses of the organism and increasing several inflammatory and immune markers. We aimed to conduct a systematic review concerning the association between CSA and indicato...

Objective: To evaluate the factorial validity and internal consistency of a measurement model underlying risk of bias as endorsed by Cochrane for use in systematic reviews; more specifically, how the risk of bias tool behaves in the context of studies on psychological therapies used for treatment of post-traumatic stress disorder in adults. Metho...

Background: The anterior cingulate gyrus is involved in the extinction of conditioned fear responses and is implicated in the pathophysiology of posttraumatic stress disorder. The expression of N-acetylaspartate and choline may be altered in the anterior cingulate gyri of children and adolescents with posttraumatic stress disorder. Methods: We c...

Background: Estimating 12-month prevalence of depression, anxiety, and comorbid anxiety/depression in noninstitutionalized adults (age 15-75) in two violence-prone cities. Methods: The Composite International Diagnostic Interview v2.1 (Portuguese), administered in population-representative surveys (age 15-75) in São Paulo (N = 2536) and Rio de J...

Background The identification of facial emotions is a key skill as it promotes rapid and accurate recognition of emotions and enables better communication and greater social adaptation. More recent studies have suggested that impaired social interactions may be related to deficits in social cognition and therefore in the recognition of facial expre...

Background: Peritraumatic dissociation has become increasingly important for both the diagnosis and the prognosis of Post-traumatic Stress Disorder (PTSD) and Acute Stress Disorder (ASD). Changes in inflammatory mediators, immune-related genes and alterations of the hypothalamic-pituitary adrenal axis are suggestive findings that support the role o...

Telomeres are repetitive DNA sequences at the ends of chromatids that shorten following each cell replication. Once telomeres reach a critical length, DNA defense mechanisms can direct cells to either a state of arrest (senescence) or apoptosis. Stress induced by adversity is a probable cause of accelerated telomere shortening from an early age. Ho...

Objectives: To assess the prevalence of elder abuse and to investigate potential sociodemographic, health behavior, and medical correlates. Design: Cross-sectional data were collected in face-to-face assessments. Setting: São Paulo and Rio de Janeiro, Brazil. Participants: Individuals aged 60 to 75. Measurements: Information on elder abuse...

Posttraumatic stress disorder (PTSD) is a common psychiatric disorder. The etiology of PTSD is multifactorial, depending on many environmental and genetic risk factors, and the exposure to life or physical integrity-threatening events. Several studies have shown significant correlations of many neurobiological findings with PTSD. Hypothalamic-pitui...

Objective: Associations between parental/caregiver depression and adverse child outcomes are well established and have been described through one or more mechanisms: child psychopathology following exposure to a depressed caregiver, child psychopathology exacerbating a caregiver’s depression, and caregiver and offspring depression sharing the same...

Background Task shifting approaches (rational redistribution of tasks among health workforce teams) to train lay professionals to assist with integrating mental health treatment in primary care has been recommended to close the mental health treatment gap for depression in low- and middle-income countries. This study aims to examine the a new model...

Scientific evidence showed significant correlations between symptoms of posttraumatic stress disorder (PTSD) and deficits in cognitive processing. Understanding how these deficits correlate with symptoms of PTSD in prospective studies can provide arguments to improve explanatory models of pathological mechanisms of this disorder. Our objective was...

PurposeTo evaluate the mental health status of children working on the streets in Sao Paulo City, Brazil, two years after their participation in a psychosocial program, and to identify factors associated with their mental health status. Methods From a total sample of 126 children working on the streets, 107 (85%) were re-evaluated two years after t...

Childhood maltreatment, which includes emotional abuse, sexual abuse, physical abuse and neglect (including witnessing domestic violence), is a global problem with several consequences, including pediatric posttraumatic stress disorder (PTSD). The study goal was to investigate the structural alterations, through a prospective study, in PTSD/PTSS pa...

Several studies have recently demonstrated that the volumes of specific brain regions are reduced in children and adolescents with post-traumatic stress disorder (PTSD) compared with those of healthy controls. Our study investigated the potential association between early traumatic experiences and altered brain regions and functions. We conducted a...

Background Teenagers and young adults are more exposed to violence and traumatic events than adults, and these factors can be associated with mental disorders. This paper aims at investigating whether young people are more exposed to violence and traumatic events and to compare pattern of mental disorders with adults. Methods Cross-sectional study...

COMT contains a functional single-nucleotide polymorphism at codon 158, with a substitution of the aminoacid valine (Val) by methionine (Met) that is associated with 3–4 fold reduction on the enzyme activity. We have previously found an interaction between COMT val/met polymorphism and PTSD development among victims of urban violence in Brazil (Val...

Peritraumatic dissociation has been considered an important feature for the development of post-traumatic stress disorders, but this concept remains widely unclear. To explore the peritraumatic experience, we interviewed eight victims of urban violence shortly after their traumatic events. The data collected were compared and analyzed according to...

COMT contains a functional single-nucleotide polymorphism at codon 158, with a substitution of the aminoacid valine (Val) by methionine (Met) that is associated with 3–4 fold reduction on the enzyme activity. We have previously found an interaction between COMT val/met polymorphism and PTSD development among victims of urban violence in Brazil (Val...

To estimate the prevalence of one month psychotropic drug use in São Paulo, Brazil, and to assess the gap treatment between the presence of mental disorders and psychotropic drug users. A probabilistic sample of non-institutionalized individuals from the general population of São Paulo (n = 2336; turnout: 84.5%) who were 15 years or older were inte...

Objective: To verify the association between violence and alcohol dependence syndrome in sample populations. Method: Population-wide survey with multistage probabilistic sample. 3,744 individuals of both genders, aged from 15 to 75 years, were interviewed from the cities of São Paulo and Rio de Janeiro using the Composite International Diagnosti...

The present study evaluated the perceived quality of life of the mothers of street children and investigated the association with their history of childhood violence, the occurrence of current domestic violence, their current mental states and that of their children, and family functioning. The applied instruments were as follows: Strengths and Dif...

Avaliamos a percepção da qualidade de vida de mães de crianças em situação de rua e investigamos a sua possível associação com os antecedentes maternos de abuso e violência na infância e vitimização atual, sintomas emocionais delas e de seus filhos e com o funcionamento familiar. Foram aplicados os seguintes instrumentos: Instrumento para a Avaliaç...

The study objective was to observe the cortisol awakening response (CAR) pattern before and after a psychosocial intervention with children from dysfunctional families who had at least one child working on the streets, and to verify factors related to it. Two hundred and eleven children between 7 and 14 years old were selected and 191 were included...

To ascertain whether genetic variations in the serotonin transporter gene (5-HTTLPR 44-bp insertion/deletion polymorphism) influence an increase in depressive and anxiety symptoms in children and adolescents exposed to high levels of violence. Saliva samples were collected from a group of children who were working on the streets and from their sibl...

O Brasil apresentou piora alarmante dos índices de violência nos últimos 30 anos. Este artigo discute dados diversos, o papel da maternagem na defi nição de como o indivíduo se relacionará social e afetivamente na vida adulta, e discorre sobre estratégias e campanhas que poderiam ajudar a reverter o grave quadro atual.

O Brasil apresentou piora alarmante dos índices de violência nos últimos 30 anos. Este artigo discute dados diversos, o papel da maternagem na defi nição de como o indivíduo se relacionará social e afetivamente na vida adulta, e discorre sobre estratégias e campanhas que poderiam ajudar a reverter o grave quadro atual.