José Miguel Caldas‐de‐Almeida

Universidade Nova de Lisboa

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Graça Cardoso

Universidade Nova de Lisboa

Ronald C. Kessler

Harvard University Press

Giovanni de Girolamo

Centro San Giovanni di Dio Fatebenefratelli

Jordi Alonso

Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública

Silvia Florescu

National School of Public Health, Management and Professional Development

Ronny Bruffaerts

KU Leuven

Kate M. Scott

University of Otago

Josep María Haro

Parc Sanitari Sant Joan de Déu

Oye Gureje

University of Ibadan

Viviane Kovess‐Masféty

Université Paris Cité

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Harvard University

188

Columbia University

Massachusetts General Hospital

University of Washington

Universidade Nova de Lisboa

UNSW Sydney

University of Lisbon

Dalhousie University

University of California, San Diego

Boston University

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How well can post-traumatic stress disorder be predicted from pre-trauma risk factors? An exploratory study in the WHO World Mental Health Surveys

World Psychiatry (2014)

Ronald C. Kessler Sherri Rose Karestan C. Koenen Elie G. Karam Paul Stang

Post-traumatic stress disorder (PTSD) should be one of the most preventable mental disorders, since many people exposed to traumatic experiences (TEs) could be targeted in first response settings in the immediate aftermath of exposure for preventive intervention. However, these interventions are costly and the proportion of TE-exposed people who develop PTSD is small. To be cost-effective, risk prediction rules are needed to target high-risk people in the immediate aftermath of a TE. Although a number of studies have been carried out to examine prospective predictors of PTSD among people recently exposed to TEs, most were either small or focused on a narrow sample, making it unclear how well PTSD can be predicted in the total population of people exposed to TEs. The current report investigates this issue in a large sample based on the World Health Organization (WHO)'s World Mental Health Surveys. Retrospective reports were obtained on the predictors of PTSD associated with 47,466 TE exposures in representative community surveys carried out in 24 countries. Machine learning methods (random forests, penalized regression, super learner) were used to develop a model predicting PTSD from information about TE type, socio-demographics, and prior histories of cumulative TE exposure and DSM-IV disorders. DSM-IV PTSD prevalence was 4.0% across the 47,466 TE exposures. 95.6% of these PTSD cases were associated with the 10.0% of exposures (i.e., 4,747) classified by machine learning algorithm as having highest predicted PTSD risk. The 47,466 exposures were divided into 20 ventiles (20 groups of equal size) ranked by predicted PTSD risk. PTSD occurred after 56.3% of the TEs in the highest-risk ventile, 20.0% of the TEs in the second highest ventile, and 0.0-1.3% of the TEs in the 18 remaining ventiles. These patterns of differential risk were quite stable across demographic-geographic sub-samples. These results demonstrate that a sensitive risk algorithm can be created using data collected in the immediate aftermath of TE exposure to target people at highest risk of PTSD. However, validation of the algorithm is needed in prospective samples, and additional work is warranted to refine the algorithm both in terms of determining a minimum required predictor set and developing a practical administration and scoring protocol that can be used in routine clinical practice.

Demographics

Traumatic stress

10.1002/wps.20150

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Disability and common mental disorders: Results from the World Mental Health Survey Initiative Portugal

European Psychiatry (2018)

Ana Antunes Diana Frasquilho Sofia Azeredo‐Lopes Daniel Neto Manuela Silva

Abstract Background Common mental disorders are highly prevalent and disabling, leading to substantial individual and societal costs. This study aims to characterize the association between disability and common mental disorders in Portugal, using epidemiological data from the World Mental Health Survey Initiative. Methods Twelve-month common mental disorders were assessed with the CIDI 3.0. Disability was evaluated with the modified WMHS WHODAS-II. Logistic regression models were used to assess the association between disability and each disorder or diagnostic category (mood or anxiety disorders). Results Among people with a common mental disorder, 14.6% reported disability. The specific diagnoses significantly associated with disability were post-traumatic stress disorder (OR: 6.69; 95% CI: 3.20, 14.01), major depressive disorder (OR: 3.49; 95% CI: 2.13, 5.72), bipolar disorder (OR: 3.41; 95% CI: 1.04, 11.12) and generalized anxiety disorder (OR: 3.14; 95% CI: 1.43, 6.90). Both categories of anxiety and mood disorders were significantly associated with disability (OR: 1.88; 95% CI: 1.23, 2.86 and OR: 3.94; 95% CI: 2.45, 6.34 respectively). Conclusions The results of this study add to the current knowledge in this area by assessing the disability associated with common mental disorders using a multi-dimensional instrument, which may contribute to mental health policy efforts in the development of interventions to reduce the burden of disability associated with common mental disorders.

CIDI

10.1016/j.eurpsy.2017.12.004

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Citations (59)

A saúde mental e a crise económica

Imprensa da Universidade de Coimbra eBooks (2015)

Manuela Silva Graça Cardoso Benedetto Saraceno José Miguel Caldas‐de‐Almeida

a crise económica

10.14195/978-989-26-1105-1_5

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Citations (4)

[Empathy in the doctor-patient relationship as viewed by first-year medical students: data on validity and sensibility to change of the Jefferson Measure in Portugal].

PubMed (2011)

José Loureiro-Amigo Manuel Gonçalves‐Pereira Bruno Trancas José Miguel Caldas‐de‐Almeida Alexandre Castro‐Caldas

Empathy is a key feature of the doctor-patient relationship. Several studies have shown a link between empathic relationships and clinical outcomes. However, reports of a decline in empathy over the course of undergraduate medical education and medical practice have raised concern among medical educators. Our study focuses on the exploration of the temporal stability of attitudes towards empathy in first-year medical students. We also aimed to characterise this sample regarding attitudes towards empathy and its associations with socio-demographic determinants, motives for entering Medicine and professional expectations. Finally, we wanted to contribute to the preliminary validation in Portugal of the Jefferson Scale of Physician Empathy, students' version (JSPE-S), following Hojat's definition of empathy as a predominantly cognitive concept.We selected a non-randomized sample of 81 first-year medical students, in Lisbon. For the evaluation of the motives for choosing Medicine as a career, we adapted a questionnaire based on the items reported by Vaglum and associates. For self-report assessment of attitudes towards empathy, we used a Portuguese translation of the JSPE- -S. Finally, we analysed the evolution of empathy-related attitudes through a six-month period that included Medical Psychology teaching (given that the curriculum would be expected to raise empathy-driven attitudes and skills).The JSPE-S total score increased from baseline to follow-up assessments (p=0.001). At the baseline, we found a negative correlation between the "status/security" motivation index and the JSPE-S "standing in patient shoes" component, while there was a positive correlation between the "people oriented" motivation index and the JSPE-S "compassionate care" factor. Psychometric properties were acceptable for both the JSPE-S and the motivation questionnaire.In general, our findings support the idea that empathy can be learnt in medical schools. This study also provides evidence for the validation of the JSPE-S and for the acceptability of an instrument assessing motivation for medical school, in Portugal. Albeit weak, the correlations between motivational factors and empathy components deserve further exploration in research.

Medical humanities

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Family burden related to mental and physical disorders in the world: results from the WHO World Mental Health (WMH) surveys

Brazilian Journal of Psychiatry (2013)

María Carmen Viana Michael J. Gruber Victoria Shahly Ali Obaid Alhamzawi Jordi Alonso

To assess prevalence and correlates of family caregiver burdens associated with mental and physical conditions worldwide.Cross-sectional community surveys asked 43,732 adults residing in 19 countries of the WHO World Mental Health (WMH) Surveys about chronic physical and mental health conditions of first-degree relatives and associated objective (time, financial) and subjective (distress, embarrassment) burdens. Magnitudes and associations of burden are examined by kinship status and family health problem; population-level estimates are provided.Among the 18.9-40.3% of respondents in high, upper-middle, and low/lower-middle income countries with first-degree relatives having serious health problems, 39.0-39.6% reported burden. Among those, 22.9-31.1% devoted time, 10.6-18.8% had financial burden, 23.3-27.1% reported psychological distress, and 6.0-17.2% embarrassment. Mean caregiving hours/week was 12.9-16.5 (83.7-147.9 hours/week/100 people aged 18+). Mean financial burden was 15.1% of median family income in high, 32.2% in upper-middle, and 44.1% in low/lower-middle income countries. A higher burden was reported by women than men, and for care of parents, spouses, and children than siblings.The uncompensated labor of family caregivers is associated with substantial objective and subjective burden worldwide. Given the growing public health importance of the family caregiving system, it is vital to develop effective interventions that support family caregivers.

Embarrassment

Cross-sectional study

Caregiver Burden

10.1590/1516-4446-2012-0919

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Citations (93)

Innovative mental health policies, plans and interventions: How to manage consequences of economic crisis?

European Psychiatry (2021)

José Miguel Caldas‐de‐Almeida

Abstract Body Available evidence shows that countries may shield their population’s exposure and vulnerability to mental health risks during and after an economic recession by strengthening their policies and reorienting their budgets. Populations’ mental health protection during economic crises can only be achieved by the policies of different sectors. Social protection, social programmes and social safety nets proved to be fundamental buffers against inequalities in mental health. Several actions have proven to be effective in this area, including measures to improve social protection, reduce income inequalities, and mitigate the impacts of unemployment. To address the negative consequences of unemployment, active labour market programmes, including special programmes for unemployed young people and families, programmes to promote the employment of people with disabilities, and debt relief programmes should be implemented. The response of the health system is critical. During and after economic recessions, it is fundamental to ensure the responsiveness and effectiveness of the mental health system. To attain this goal, mental health services that are closer to the populations and that facilitate the early identification of mental health problems and the implementation of integrated interventions should be strengthened. The latter is a crucial approach to tackle the mental health problems that more often worsen in periods of economic instability, such as depression, suicidal behaviour and heavy drinking. A special attention should also be dedicated to strengthening the network of community-based mental health services, promoting the integration of mental health in primary care, and enhancing the coordination between mental health services and social care. Disclosure No significant relationships.

Vulnerability

10.1192/j.eurpsy.2021.215

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I bisogni assistenziali nei pazienti schizofrenici. Primi risultati comparativi di una ricerca Europea

Bernardo Carpiniello Manolo Carta D. Wiersma V. Kovess Alcir de Souza Caria

Background. This paper presents the preliminary results of the Italian centre of a European research project regarding the evaluation of needs for care of schizophrenic patients, compared with overall results from the 10 centres of 7 European countries participating to the project. Methods. A cohort of 504 schizophrenic patients according ICD-10, randomly selected among those who were in contact with mental health services, was clinically studied by means of a structured interview (SCAN). Needs of care were also studied by means of a structured instruments the Needs for Care Assessment Schedule (NFCAS). Results. The average patient affected by schizophrenia who was in charge of the mental health service was mainly male (68% of cases), between 35 and 43 years old, and ill for about 15 years, unmarried and living alone or with parents, mostly unemployed and dependent on social benefits. In the Italian centre, the average number of clinical and social problems of this patient was 8 respect to 6 of the entire European sample; the rate of meet/unmeet needs was approx: 2:1 respect to 8:1 on the average in Europe. 100% of schizophrenic subjects of the Italian centre showed at least one unmeet need respect to 44% on the average in Europe. Conclusions. Unmeet needs were significantly and inversely correlated with the number of community based, residential and semiresi- dential facilities.

Social needs

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Intersocietal Venous Insurance and Government Relations Committee: Confronting Bogus Policies Used by Insurers

José Miguel Caldas‐de‐Almeida

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Health conditions and role limitation in three European Regions: a public-health perspective

Gaceta Sanitaria (2016)

Gabriela Barbaglia Núria D. Adroher Gemma Vilagut Ronny Bruffaerts Brentan Bunting

To describe the distribution of role limitation in the European population aged 18-64 years and to examine the contribution of health conditions to role limitation using a public-health approach.Representative samples of the adult general population (n=13,666) aged 18-64 years from 10 European countries of the World Mental Health (WMH) Surveys Initiative, grouped into three regions: Central-Western, Southern and Central-Eastern. The Composite International Diagnostic Interview (CIDI 3.0) was used to assess six mental disorders and standard checklists for seven physical conditions. Days with full and with partial role limitation in the month previous to the interview were reported (WMH-WHODAS). Population Attributable Fraction (PAFs) of full and partial role limitation were estimated.Health conditions explained a large proportion of full role limitation (PAF=62.6%) and somewhat less of partial role limitation (46.6%). Chronic pain was the single condition that consistently contributed to explain both disability measures in all European Regions. Mental disorders were the most important contributors to full and partial role limitation in Central-Western and Southern Europe. In Central-Eastern Europe, where mental disorders were less prevalent, physical conditions, especially cardiovascular diseases, were the highest contributors to disability.The contribution of health conditions to role limitation in the three European regions studied is high. Mental disorders are associated with the largest impact in most of the regions. There is a need for mainstreaming disability in the public health agenda to reduce the role limitation associated with health conditions. The cross-regional differences found require further investigation.

CIDI

European population

10.1016/j.gaceta.2016.07.008

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Citations (9)

Young People Living with Unemployed Parents during a Labour Market-Crisis: How Do Portugal and Scotland Compare?

Child Indicators Research (2016)

Diana Frasquilho Margarida Gaspar de Matos Candace Currie Fergus Neville Ross Whitehead

Youth Unemployment

10.1007/s12187-016-9436-5

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Citations (3)