SAO PAULO
Sergio Baxter Andreoli
Prevalence studies of mental disorders in Brazil
Presidente do Centro de Estudos do Departamento
de
Psiquiatria e Psicologia Medica da Universidade
Federal
de Slio Paulo -
UNIFESP
C o m m u n ity p re v a le n c e s tu d ie s o f m e n ta l d is o rd e r b e
-g a n w ith J a v is in 1 9 5 5 in M a s s a c h u s e tts . B e fo re th e s e c o n d
w o rld w a r o th e r s tu d ie s w e re u n d e rta k e n in U S A , s u c h a s th o s e
b y L e n k a u (1 9 5 8 ) in B a ltim o re a n d b y R o th a n d L u to n (1 9 4 3 )
in T e n n e s s e e . T h e s e s tu d ie s , a lth o u g h a d v a n c e d fo r th e ir tim e ,
w e re lim ite d in te rm s o f c a s e id e n tific a tio n . J a v is c a lc u la te d
th e fre q u e n c y o f " in s a n ity " a n d " id io c y " b y m e a n s o f in te
r-v ie w s w ith c o m m u n ity le a d e rs , a n d L e n k a u e s tim a te d th e fre
-q u e n c y o f " n e rv o u s n e s s " u s in g u n s tru c tu re d in te rv ie w s w ith
s u b je c ts . T h e s e s tu d ie s u s e d v a g u e d ia g n o s tic c o n c e p ts a n d
d id n o t ta k e in to a c c o u n t re lia b ility a n d v a lid ity (W e is s m a n ,
1 9 8 7 ).
A fte r th e s e c o n d w o rld w a r, g re a te r m e th o d o lo g ic a l rig o r
w a s in tro d u c e d , w ith m o re a tte n tio n b e in g p a id to is s u e s s u c h
a s s a m p lin g , d a ta c o lle c tio n , a n d s ta tis tic a l a n a ly s is . D e s p ite
th e s e im p ro v e m e n ts , th e d ia g n o s tic p ro c e s s c o n tin u e d to la c k
re lia b ility . G lo b a l m e a s u re s o f a s s e s s m e n t w e re u s e d w h ic h
d id n o t fit n e a tly w ith th e c lin ic a l p ic tu re (W e is s m a n , 1 9 8 7 ).
T h e d iv e rg e n t s tra n d s o f e p id e m io lo g ic a l p s y c h ia try ,
c lin ic a l p s y c h ia try a n d a c a d e m ic re s e a rc h b e g a n to c o n v e rg e
in th e 1 9 7 0 's w ith th e in tro d u c tio n o f s p e c ific d ia g n o s tic c
ri-te ria . S ta n d a rd iz e d in te rv ie w s im p ro v e d th e id e n tific a tio n a n d
q u a n tific a tio n o f s ig n s a n d s y m p to m s , g re a tly in c re a s in g d
i-a g n o s tic re lia b ility (W e is s m a n , 1 9 8 7 ).
In th e 1 9 7 0 's th e s e in s tru m e n ts w e re u s e d in e p id e m io
-lo g ic a l s tu d ie s to id e n tify p s y c h ia tric c a s e s in th e c o m m u n ity .
O n e im p o rta n t a d v a n c e th a t o c c u re d d u rin g th is p e rio d w a s
th a t th e u s e o f c o n v e n ie n c e s a m p le s , s u c h a s h o s p ita liz e d
p a tie n ts , g a v e a n in c o m p le te p ic tu re o f th e d is o rd e r. In n o n
-tre a te d in d iv id u a ls , p s y c h o p a th o lo g y o fte n d iffe rs fro m th e
te x tb o o k d e s c rip tio n s (D o h re n w e n d e t a I., 1 9 8 0 ).
D e s p ite th e s e a d v a n c e s , it is o n ly re ~ e n tly th a t in v e s
ti-g a to rs h a v e b e ti-g u n to s tu d y B ra z ilia n c o m m u n itie s (S a n ta n a
e t a I., 1 9 8 8 ). In 1 9 7 4 , C o u tin h o (1 9 7 6 ) e s tim a te d th e p re v a
-le n c e o f m e n ta l d is o rd e r in S a lv a d o r, u s in g a tw o -s te p m e th o d
(id e n tify in g s u s p e c te d c a s e s a n d th e n m a k in g d e fin itiv e d ia g
-n o s e s ). T h e m e th o d o lo g ic a l w e a k n e s s e s o f th is s tu d y w e re
th a t th e in s tru m e n ts u s e d h a d b e e n in s u ffic ie n tly v a lid a te d
a n d th e d ia g n o s tic s y s te m w a s u n d e fin e d . In 1 9 7 4 , L u z e s
ti-m a te d th e p re v a le n c e o f a lc o h o lis m in th e p o p u la tio n o f V ila
V a rg a s , P o rto A le g re . In 1 9 7 6 a s e rie s o f p o p u la tio n s tu d ie s
s ta rte d in d iffe re n t s e c to rs o f th e m e tro p o lita n c ity o f S a lv a
d o l', B a h ia . T h e a im o f th e s e s tu d ie s w a s to d e v e lo p tw o s c re e n
-in g -in s tru m e n ts - th e a d u lt p s y c h ia try m o rb id ity q u e s tio n n a ire
(Q M P A ) (S a n ta n a , 1 9 8 2 ) a n d th e c h ild re n 's p s y c h ia tric m o
r-b id ity q u e s tio n n a ire (Q M P I) (A lm e id a -F ilh o , 1 9 8 5 ). T h e s e
D a v e b e e n u s e d in a ra n g e o f d e s c rip tiv e a n d a n a ly tic e p id e
-m io lo g ic a l s tu d ie s (A lm e id a -F ilh o , 1 9 8 1 , 1 9 8 2 , 1 9 8 5 ;
S a n ta n a , 1 9 8 2 ; A lm e id a -F ilh o & B a s to s , 1 9 8 2 ; A lm e id a -F ilh o
e t a I., 1 9 8 3 , 1 9 8 4 ; D u n n ig h a n , 1 9 8 5 ; S a n ta n a & A lm e id a
-F ilh o , 1 9 8 5 ; B a s to s , 1 9 8 6 ). B e fo re 1 9 7 6 , B ra z ilia n s tu d ie s
w e re o f lo w d ia g n o s tic re lia b ility ; e v e n th o s e u s in g th e tw o
-s te p m e th o d te n d e d to u -s e n o n --s ta n d a rd iz e d d ia g n o s tic c rite
-n a .
D u rin g th e e a rly 1 9 9 0 's fo u r p o p u la tio n s u rv e y s w e re
c a rrie d o u t w h o s e m e th o d o lo g ic a l s tre n g th s , re g a rd in g c a s e
id e n tific a tio n , s ta n d o u t, . B la y e t a I's (1 9 9 1 ) s tu d y o f e ld e rly
p e o p le in th e c ity o f S a o P a u lo ; A lm e id a -F ilh o e t a I's . (1 9 9 2 )
la rg e s c a le e p id e m io lo g ic a l s tu d y in th re e B ra z ilia n c itie s ;
A lm e id a a n d C o u tin h o 's (1 9 9 3 ) p re v a le n c e s tu d y o f a lc o h o l
m is u s e o n G o v e rn o r's Is la n d (R io d e J a n e iro ); a n d P e c h a n s k y 's
(1 9 9 3 ) s tu d y o f a lc o h o l c o n s u m p tio n a m o n g a d o le s c e n ts in
th e c ity P o rto A le g re .
T h e M u ltic e n te r S tu d y o f P s y c h ia tric M o rb id ity in U
r-b a n A re a s is t~ e firs t p o p u la tio n p re v a le n c e s u rv e y u n d e
r-ta k e n in B ra z il th a t u s e s s r-ta n d a rd iz e d m e th o d o lo g y fo r c a s e
d e fin itio n a n d id e n tific a tio n (A lm e id a -F ilh o e t a I., 1 9 9 2 ). T h is
s tu d y u s e d a tw o -s te p a p p ro a c h to c a s e id e n tific a tio n . In th e
firs t s ta g e 6 ,4 7 0 in d iv id u a ls , a b o v e th e a g e o f 1 5 , w e re in te
r-v ie w e d w ith th e Q M P A s c re e n in g in s tru m e n t. In th e s e c o n d
s ta g e a s a m p le o fQ M P A -id e n tifie d " c a s e s " w e re in te rv ie w e d
w ith th e D S M III S y m p to m C h e c k lis t (A m e ric a n P s y c h ia tric
A s s o c ia tio n , 1 9 8 0 ). T h e d a ta c o lle c te d in th is s tu d y a re c u
r-re n tly b e in g a n a ly z e d b y s e v e ra l g ro u p s o f re s e a rc h e rs a n d .
s o m e fin d in g s h a v e a lre a d y b e e n p u b lis h e d (A n d re o li, 1 9 9 3 ;
A n d re o li e t a I., 1 9 9 4 ; B u s n e llo e t a i, 1 9 9 3 ; C o u tin h o , 1 9 9 3
a n d S o a re s , 1 9 9 4 ).
A s c a n b e s e e n , p s y c h ia tric e p id e m io lo g y in B ra z il is
s o m e w a y b e h in d th a t in th e U S A o r E n g la n d b u t is b e g in n in g
to d e v e lo p a n d a d v a n c e in te rm s o f m e th o d o lo g ic a l s tin g e n c y .
S u p p o rte d b y F A P E S P (G ra n t n ° 9 4 /0 5 2 6 -0 ) P s y c h ia
t-ric o f D e p a rta m e n to d e P s iq u ia tria e P s ic o lo g ia M e d ic a d a
U n iv e rs id a d e F e d e ra l d e S a o P a u lo - E s c o la P a u lis ta d e
M e d ic in a .
