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. 2013 May 8;8(5):e63545.
doi: 10.1371/journal.pone.0063545. Print 2013.

The impact of epidemic violence on the prevalence of psychiatric disorders in Sao Paulo and Rio de Janeiro, Brazil

Wagner Silva Ribeiro  1 , Jair de Jesus Mari, Maria Inês Quintana, Michael E Dewey, Sara Evans-Lacko, Liliane Maria Pereira Vilete, Ivan Figueira, Rodrigo Affonseca Bressan, Marcelo Feijó de Mello, Martin Prince, Cleusa P Ferri, Evandro Silva Freire Coutinho, Sérgio Baxter Andreoli
Affiliations

The impact of epidemic violence on the prevalence of psychiatric disorders in Sao Paulo and Rio de Janeiro, Brazil

Wagner Silva Ribeiro et al. PLoS One. .

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).

Aims: To study the relationship between traumatic events and prevalence of mental disorders in São Paulo and Rio de Janeiro, Brazil.

Methods: 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.

Results: 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).

Conclusion: 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.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interest exist.

Figures

Figure 1
Figure 1. Figure 1 shows the patterns of exposure to three types of traumatic events (assaultive violence, other injury or shocking events, and sudden death/life-threatening illness of a close person) in Sao Paulo and Rio de Janeiro, Brazil.
The diagram shows that, from the 3234 participants in the total sample who experienced at least one lifetime traumatic event, 1330 (41%) reported two types of traumatic events –906 (41.7%) in Sao Paulo and 427 (39.5%) in Rio de Janeiro, and 1121 (34.7%) experienced the three types of traumatic events –697 (32.1%) in Sao Paulo and 424 (39.5%) in Rio de Janeiro.
See this image and copyright information in PMC

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