Introduction: Globally, depression rates are high among men who have sex with men (MSM). Multiple factors may interact synergistically to increase this risk. This analysis assessed the prevalence of symptoms of depression among MSM in Brazil and synergistic effects of several factors. Methods: Cross-sectional study conducted in 12 cities using respondent-driven sampling. Sociodemographic and behavioral characteristics were collected. The PHQ-9 was used to screen for depression. Having moderate-severe depressive symptoms was compared to none-mild using logistic regression. The syndemic factor was a composite of hazardous alcohol use, sexual violence, and discrimination due to sexual orientation. Those with one to three of these factors were compared to those with none. Results: The weighted prevalence of moderate-severe depressive symptoms was 24.9% (95%CI = 21.8-28.8) and 16.2%, 22.9%, 46.0% and 51.0% when none, one, two, or three syndemic factors were present, respectively, indicating a dose-response effect. Perception of HIV risk, high level of HIV knowledge, known HIV infection, and health self-rated as poor or very poor were also associated with depressive symptoms. Conclusion: The prevalence of moderate-severe depressive symptoms among MSM in Brazil is high, and selected factors act synergistically in increasing their prevalence. Public health policies should consider holistic depression prevention and treatment interventions for this population.

Objective: Human immunodeficiency virus (HIV) prevention efficacy trials with psychiatric patients have been conducted in research settings in high-resourced countries, establishing short-term efficacy for reducing sexual risk behavior. None has been implemented within systems of care. In the last decade, overcoming this research-to-practice gap has become a focus of implementation science. This paper describes the first and only HIV Prevention intervention trial for psychiatric patients conducted in real-world outpatient psychiatric settings facilitated by trained clinic-based providers. Methods: The HIV Prevention intervention, which uses the Information-Motivation-Behavioral Skills model to achieve sexual risk-reduction, was rigorously adapted to the local context and clinic services’ needs. Participants from eight clinics were randomized to HIV Prevention or Health Promotion conditions. Results: HIV Prevention participants showed significant improvement in Information-Motivation-Behavioral domains; in this group, behavioral intentions were associated with significantly fewer unprotected sex occasions, but reduction of unprotected sex occasions was similar in both conditions. Conclusion: Our trial was conducted before implementation studies became widely funded. Transporting an intervention to a new culture or into real-world practice settings may require adaptations. Our results demonstrate that clear guidelines are needed regarding whether to conduct efficacy, effectiveness, and/or implementation research as the most appropriate next step. Clinical trial registration: NCT00881699

Mental disorders can affect up to 70% of individuals with tuberculosis (TB). The World Health Organization (WHO) End TB Strategy explicitly calls for TB and mental health service integration. The goal of this study was to explore the barriers and facilitators to integrating depression treatment in the TB Control Program and primary care system in the municipality of Itaboraí - Rio de Janeiro, using Interpersonal Counseling (IPC). IPC is an evidence-based treatment for depression that can be delivered by non-mental health specialists with expert supervision. This study was conducted between 2016 and 2017 in the municipality of Itaboraí. Data collection consisted of six focus groups (n = 42) with health professionals (n = 29), program coordinators (n = 7) and TB patients (n = 6). The main potential barriers identified were poverty, political instability, an overburdened and under-resourced health system, high levels of distress among professionals, violence in the community and stigma related to mental health and TB. Potential facilitators included a high receptivity to, and demand for, mental health training; strong community relationships through the Community Health Workers (CHW); overall acceptability of IPC delivered by non-specialists for the treatment of depression among individuals with and without comorbid TB. Despite many challenges, integrating depression treatment into primary care in Itaboraí using IPC was perceived as an acceptable and feasible option.

Os transtornos mentais podem afetar até 70% dos indivíduos com tuberculose (TB). A Organização Mundial da Saúde (OMS), como estratégia para o fim da TB, exige a integração do seu tratamento com a saúde mental. O objetivo deste estudo foi explorar as barreiras e facilitadores para integrar serviços de saúde mental no Programa de Controle de Tuberculose (PCT) e em Unidades de Saúde da Família (USF) do município de Itaboraí – Rio de Janeiro, com a aplicação do Aconselhamento Interpessoal (AIP). O AIP é um tratamento para depressão baseado em evidências que pode ser aplicado por não especialistas em saúde mental com supervisão especializada. Seis grupos focais foram realizados entre 2016 e 2017 no município de Itaboraí. A amostra (n=42) incluiu profissionais de saúde (n=29), coordenadores de programas (n=7) e pacientes com TB (n=6). Os grandes desafios encontrados foram: pobreza, instabilidade política, um sistema de saúde sobrecarregado e com poucos recursos, alta frequência de estresse entre os profissionais, violência na comunidade e estigma relacionado à saúde mental e à TB. Os facilitadores potenciais incluíram uma grande receptividade e demanda para capacitações em saúde mental; boa relação com a comunidade pelos Agentes Comunitários de Saúde (ACS) e; aceitação geral do AIP aplicado por não especialistas em saúde mental para o tratamento de depressão em pessoas com e sem TB. Apesar de muitos desafios, integrar o tratamento de depressão na atenção primária de Itaboraí aplicando o AIP foi percebido como uma alternativa aceitável e factível.

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 etiology. Data from low and middle-income countries is scarce. We examined correlations between common symptoms of mental disorders in caregivers and their offspring’s psychopathology in a Brazilian sample. Methods: In this cross-sectional study, adult caregivers were screened for depression during routine home visits by community health workers as part of the Brazilian Family Health Strategy. Caregivers with suspected depression were assessed using the Zung Self-Rating Depression Scale and the Self-Reporting Questionnaire (SRQ-20). Children’s symptoms were evaluated using the Strengths and Difficulties Questionnaire (SDQ). Results: The sample included 68 primary caregivers and 110 children aged 6 to 15 years. Higher caregiver scores on the SRQ-20 correlated significantly with psychiatric symptoms in offspring. Conclusion: These results substantiate our hypothesis that child psychopathology correlates with caregivers’ psychiatric symptoms. This paper adds to the growing literature on community mental health assessment and can help guide future strategies for reducing the burden of common mental disorders in caregivers and children alike in low and middle-income countries.

Abstract Background Burnout is a multidimensional syndrome and includes symptoms of emotional exhaustion, depersonalization, and reduced personal accomplishment at work. Oncology health care providers are at high risk to develop symptoms of burnout because of work-related stressors. Adaptive coping strategies adopted to deal with stressors may prevent the development of burnout. Objective The present study aims to assess the association between burnout, functional coping strategies, and occupational factors in a sample of oncology providers, mostly nurses. Methods Sociodemographic Questionnaire, the Maslach Burnout Inventory, and the Problem Solving Inventory “Inventário de Resolução de Problemas” were administered. Descriptive, correlational, and linear regression analyses were performed. Results The study showed that emotional exhaustion correlated with lower levels of adaptive coping, less years of experience in Oncology, and a greater amount of hours worked per week. Personal accomplishment was associated with the adaptive coping strategies. No further statistically significant associations were identified. Discussion Our findings support the importance of adaptive coping strategies in order to prevent symptoms of burnout when health professionals face potentially stressful occupational factors. Training aimed at improving adaptive coping skills may prevent burnout syndrome for health care professionals working in Oncology.

RESUMO Objetivo Avaliamos as propriedades psicométricas de um novo instrumento “Mental Illness Sexual Stigma Questionnaire” (MISS-Q; Questionário de Estigma Sexual na Doença Mental). Métodos Entrevistamos 641 adultos sexualmente ativos (18 a 80 anos), frequentando clínicas psiquiátricas ambulatoriais públicas no Rio de Janeiro sobre suas experiências de estigma. Resultados Foram extraídos nove fatores por meio da análise exploratória fatorial e rotulados: 'discriminação individual por parte de outros'; 'disposição pessoal para falar sobre sexualidade'; proibições pessoais e familiares; 'desvalorização sexual de si mesmo'; 'percepção de atratividade'; 'dissimulação da doença mental'; 'percepção da competência de papel sexual'; 'retirada'; e 'locus de sociosexual ao controle'. 'Retirada' e 'locus de controle social-sexual' mostraram propriedades psicométricas fracas e foram excluídos da análise posterior. Os sete fatores restantes tinham altas cargas fatoriais (0,39 a 0,86), variando de suficiente até confiabilidade ótima (Ordinal α variou de ,57 a ,88), e boa validade convergente e discriminante. Conclusões O resultante MISS-Q é o primeiro instrumento que avalia o estigma sexual da doença mental com propriedades psicométricas demonstradas. Pode ser útil na redução do estigma, proteção da saúde sexual e promoção à recuperação.

ABSTRACT Objective We evaluated the psychometric properties of a new instrument “Mental Illness Sexual Stigma Questionnaire” (MISS-Q). Methods We interviewed 641 sexually active adults (ages 18-80) attending public outpatient psychiatric clinics in Rio de Janeiro about their stigma experiences. Results Nine factors were extracted through exploratory factor analysis (EFA) and labeled: ‘individual discrimination by others’; ‘staff willingness to talk about sexuality’; ‘staff and family prohibitions’; ‘sexual devaluation of self’; ‘perceived attractiveness’; ‘mental illness concealment’; ‘perceived sexual role competence’; ‘withdrawal’; and ‘locus of social-sexual control’. ‘Withdrawal’ and ‘locus of social-sexual control’ showed poor psychometric properties and were excluded from further analysis. The remaining seven factors had high factorial loadings (.39 to .86), varying from sufficient to optimal reliability (Ordinal α ranged from .57 to .88), and good convergent and discriminant validity. Conclusions The resulting MISS-Q is the first instrument assessing mental illness sexual stigma with demonstrated psychometric properties. It may prove useful in reducing stigma, protecting sexual health, and promoting recovery.

ABSTRACT OBJECTIVE To estimate factors associated to illicit drug use among patients with mental illness in Brazil according to gender. METHODS A cross-sectional representative sample of psychiatric patients (2,475 individuals) was randomly selected from 11 hospitals and 15 public mental health outpatient clinics. Data on self-reported illicit drug use and sociodemographic, clinical and behavioral characteristics were obtained from face-to-face interviews. Logistic regression was used to estimate associations with recent illicit drug use. RESULTS The prevalence of any recent illicit drug use was 11.4%. Men had higher prevalence than women for all substances (17.5% and 5.6%, respectively). Lower education, history of physical violence, and history of homelessness were associated with drug use among men only; not professing a religion was associated with drug use in women only. For both men and women, younger age, current hospitalization, alcohol and tobacco use, history of incarceration, younger age at sexual debut, and more than one sexual partner were statistically associated with illicit drug use. CONCLUSIONS Recent illicit drug use among psychiatric patients is higher than among the general Brazilian population and it is associated with multiple factors including markers of psychiatric severity. Our data indicate the need for the development of gender-based drug-use interventions among psychiatric patients in Brazil. Integration of substance use treatment strategies with mental health treatment should be a priority.

ABSTRACT OBJECTIVE To estimate factors associated to illicit drug use among patients with mental illness in Brazil according to gender. METHODS A cross-sectional representative sample of psychiatric patients (2,475 individuals) was randomly selected from 11 hospitals and 15 public mental health outpatient clinics. Data on self-reported illicit drug use and sociodemographic, clinical and behavioral characteristics were obtained from face-to-face interviews. Logistic regression was used to estimate associations with recent illicit drug use. RESULTS The prevalence of any recent illicit drug use was 11.4%. Men had higher prevalence than women for all substances (17.5% and 5.6%, respectively). Lower education, history of physical violence, and history of homelessness were associated with drug use among men only; not professing a religion was associated with drug use in women only. For both men and women, younger age, current hospitalization, alcohol and tobacco use, history of incarceration, younger age at sexual debut, and more than one sexual partner were statistically associated with illicit drug use. CONCLUSIONS Recent illicit drug use among psychiatric patients is higher than among the general Brazilian population and it is associated with multiple factors including markers of psychiatric severity. Our data indicate the need for the development of gender-based drug-use interventions among psychiatric patients in Brazil. Integration of substance use treatment strategies with mental health treatment should be a priority.

OBJETIVO: Analisar fatores associados ao recebimento de resultados de exames sorológicos para HIV e outras infecções sexualmente transmissíveis (IST) entre pacientes psiquiátricos. MÉTODOS: Estudo de corte transversal multicêntrico nacional de 2.080 participantes selecionados aleatoriamente dentre 26 instituições de saúde mental brasileiras em 2007. O efeito do indivíduo (nível 1) e dos serviços de saúde mental (nível 2) no recebimento dos resultados dos exames foi avaliado utilizando-se regressão logística multinível. RESULTADOS: A proporção de retorno dos resultados de exames HIV/IST foi de 79,6%. Entre as características individuais, houve associação do desfecho com: viver na mesma cidade onde se encontravam os serviços, ser solteiro, não ter ouvido falar sobre aids e não ter sido previamente testado para HIV. Entre as características dos serviços de saúde, apenas distribuição de preservativos esteve associada ao recebimento dos resultados de exames. CONCLUSÕES: É urgente promover melhor integração entre os serviços de saúde, além de expandir a oferta de exame anti-HIV e outras IST, em especial em serviços de atenção a pacientes psiquiátricos potencialmente mais vulneráveis a essas condições.

OBJECTIVE: To assess individual and/or health service factors associated with patients returning for results of HIV or sexually transmitted infection (STI) tests in mental health centers. METHODS: Cross-sectional national multicenter study among 2,080 patients randomly selected from 26 Brazilian mental health centers in 2007. Multilevel logistic regression was used to assess the effect of individual (level 1) and mental health service characteristics (level 2) on receipt of test results. RESULTS: The rate of returning HIV/STI test results was 79.6%. Among health service characteristics examined, only condom distribution was associated with receiving HIV/STI test results, whereas several individual characteristics were independently associated including living in the same city where treatment centers are; being single; not having heard of AIDS; and not having been previously HIV tested. CONCLUSIONS: It is urgent to expand HIV/STI testing in health services which provide care for patients with potentially increased vulnerability to these conditions, and to promote better integration between mental health and health services.

OBJETIVO: Analizar factores asociados a la recepción de resultados de exámenes serológicos para VIH y otras infecciones de transmisión sexual (ITS) entre pacientes psiquiátricos. MÉTODOS: Estudio de corte transversal multicéntrico nacional de 2.080 participantes seleccionados aleatoriamente entre 26 instituciones brasileñas de salud mental en 2007. El efecto del individuo (nivel 1) y de los servicios de salud mental (nivel 2) en la recepción de los resultados de los exámenes fue evaluado utilizándose regresión logística multinivel. RESULTADOS: La proporción de retorno de los resultados de exámenes VIH/ITS fue 79,6%. Entre las características individuales, hubo asociación del desenlace con: vivir en la misma ciudad donde se encontraban los servicios, ser soltero, no haber escuchado hablar sobre el sida, y no haber sido previamente evaluado para VIH. Entre las características de los servicios de salud, sólo la distribución de preservativos estuvo asociada a la recepción de los resultados de los exámenes. CONCLUSIONES: El retorno de los resultados de exámenes indicó que es urgente promover una mejor integración entre los servicios de salud, así como expandir la oferta de examen anti-VIH y otras ITS, en especial en servicios de atención a pacientes psiquiátricos potencialmente más vulnerables a estas condiciones.

OBJETIVO: Analisar fatores associados ao recebimento de resultados de exames sorológicos para HIV e outras infecções sexualmente transmissíveis (IST) entre pacientes psiquiátricos. MÉTODOS: Estudo de corte transversal multicêntrico nacional de 2.080 participantes selecionados aleatoriamente dentre 26 instituições de saúde mental brasileiras em 2007. O efeito do indivíduo (nível 1) e dos serviços de saúde mental (nível 2) no recebimento dos resultados dos exames foi avaliado utilizando-se regressão logística multinível. RESULTADOS: A proporção de retorno dos resultados de exames HIV/IST foi de 79,6%. Entre as características individuais, houve associação do desfecho com: viver na mesma cidade onde se encontravam os serviços, ser solteiro, não ter ouvido falar sobre aids e não ter sido previamente testado para HIV. Entre as características dos serviços de saúde, apenas distribuição de preservativos esteve associada ao recebimento dos resultados de exames. CONCLUSÕES: É urgente promover melhor integração entre os serviços de saúde, além de expandir a oferta de exame anti-HIV e outras IST, em especial em serviços de atenção a pacientes psiquiátricos potencialmente mais vulneráveis a essas condições.

OBJECTIVE: To assess individual and/or health service factors associated with patients returning for results of HIV or sexually transmitted infection (STI) tests in mental health centers. METHODS: Cross-sectional national multicenter study among 2,080 patients randomly selected from 26 Brazilian mental health centers in 2007. Multilevel logistic regression was used to assess the effect of individual (level 1) and mental health service characteristics (level 2) on receipt of test results. RESULTS: The rate of returning HIV/STI test results was 79.6%. Among health service characteristics examined, only condom distribution was associated with receiving HIV/STI test results, whereas several individual characteristics were independently associated including living in the same city where treatment centers are; being single; not having heard of AIDS; and not having been previously HIV tested. CONCLUSIONS: It is urgent to expand HIV/STI testing in health services which provide care for patients with potentially increased vulnerability to these conditions, and to promote better integration between mental health and health services.

OBJETIVO: Analizar factores asociados a la recepción de resultados de exámenes serológicos para VIH y otras infecciones de transmisión sexual (ITS) entre pacientes psiquiátricos. MÉTODOS: Estudio de corte transversal multicéntrico nacional de 2.080 participantes seleccionados aleatoriamente entre 26 instituciones brasileñas de salud mental en 2007. El efecto del individuo (nivel 1) y de los servicios de salud mental (nivel 2) en la recepción de los resultados de los exámenes fue evaluado utilizándose regresión logística multinivel. RESULTADOS: La proporción de retorno de los resultados de exámenes VIH/ITS fue 79,6%. Entre las características individuales, hubo asociación del desenlace con: vivir en la misma ciudad donde se encontraban los servicios, ser soltero, no haber escuchado hablar sobre el sida, y no haber sido previamente evaluado para VIH. Entre las características de los servicios de salud, sólo la distribución de preservativos estuvo asociada a la recepción de los resultados de los exámenes. CONCLUSIONES: El retorno de los resultados de exámenes indicó que es urgente promover una mejor integración entre los servicios de salud, así como expandir la oferta de examen anti-VIH y otras ITS, en especial en servicios de atención a pacientes psiquiátricos potencialmente más vulnerables a estas condiciones.

OBJETIVO: A prevalência do HIV em pacientes psiquiátricos é maior do que na população geral em diversos países. Diversos comportamentos de risco têm sido identificados em estudos em países desenvolvidos e em desenvolvimento. Entretanto, limitações amostrais restringem a generalização dos resultados em sua grande maioria. O objetivo deste trabalho foi apresentar resultados do primeiro estudo representativo de uma amostra nacional de pacientes psiquiátricos sobre a prática do sexo desprotegido e seus fatores associados. MÉTODO: Uma amostra representativa de pacientes adultos com transtornos mentais foi aleatoriamente selecionada de instituições públicas de saúde mental no Brasil. Dados sociodemográficos, comportamentais e clínicos foram obtidos por entrevista face-a-face e sangue foi coletado para exames sorológicos. Foi utilizada regressão logística para análise estatística. RESULTADOS: A prevalência da prática do sexo desprotegido ao longo da vida foi de 80,3%. Pacientes casados/em união, mais velhos e do sexo feminino, aqueles com múltiplos parceiros e morando somente com filhos ou com parceiros e aqueles com condições psiquiátricas menos graves praticaram o sexo desprotegido mais frequentemente. DISCUSSÃO: A avaliação de comportamentos de risco é um instrumento crítico para que profissionais de saúde sejam capazes de determinar as necessidades de cuidados relacionados ao HIV para seus pacientes garantindo o acesso ao tratamento e prevenção. Intervenções que abordam situações de risco na vida dos pacientes psiquiátricos - institucional ou individual - e que contribuam para sua capacidade de tomar decisões informadas sobre sua saúde sexual são urgentemente necessárias.

OBJECTIVE: The prevalence of HIV among psychiatric patients is higher than general population rates worldwide. Many risk behaviors have been identified in studies from both developing and developed countries, though sampling limitations restrict the generalizability of their results. The objective of this study was to report findings from the first national sample of psychiatric patients about lifetime practice of unsafe sex and associated factors. METHOD: A national multicenter sample of adults with mental illness was randomly selected from 26 public mental health institutions throughout Brazil. Sociodemographic, sexual behavior and clinical data were obtained from person-to-person interviews and blood was collected for serology testing. Logistic regression was used for analysis. RESULTS: The overall prevalence of lifetime unprotected sex was 80.3%. Married, older, female patients, those with multiple partners and living with children or partners only and those with less severe psychiatric diagnosis more often practised unsafe sex. DISCUSSION: Risk behavior assessment is a critical tool for clinicians to be able to determine needed HIV-related services for their clients and ensure appropriate follow-through with care and prevention. Interventions that address situational risks in psychiatric patients' lives-institutional and individual- and increase their ability to make informed decisions about their sexual health are urgently needed.

Este artigo apresenta dados da fase formativa, de base etnográfica, do Projeto Interdisciplinar em Sexualidade, Saúde Mental e AIDS (PRISSMA) patrocinado pelo National Institute of Mental Health (NIMH) e desenvolvido em duas instituições psiquiátricas da cidade do Rio de Janeiro, Brasil. São descritos e discutidos os resultados obtidos nas observações etnográficas, grupos focais e entrevistas com informantes-chave realizados com diferentes grupos de profissionais de saúde mental e usuários de saúde mental do hospital-dia e/ou em tratamento ambulatorial, relativos às concepções de sexualidade e vulnerabilidade para o HIV. Os resultados sugerem uma diversidade de relatos e noções sobre o exercício da sexualidade por ambos os grupos e aponta para o alto risco sexual para o HIV nessa população psiquiátrica. Esta fase formativa embasou a adaptação cultural e a criação de uma intervenção brasileira para prevenção desse vírus em portadores de transtornos mentais graves cuja viabilidade foi avaliada com sucesso na fase piloto.

This paper presents data from the ethnographic based formative phase of the Interdisciplinary Project on Sexuality, Mental Health, and AIDS (PRISSMA), sponsored by the National Institute of Mental Health (NIMH) and carried out in two psychiatric institutions in the city of Rio de Janeiro, Brazil. Results from ethnographic observations, focus groups, and key informant interviews with different groups of mental health care providers and day hospital and outpatient mental health clients regarding conceptions of sexuality and HIV vulnerability are described. The results suggest a diversity of notions about sexuality by both groups and point out the high HIV sexual risk in this psychiatric population. This formative phase has served as the basis for the cultural adaptation and creation of a Brazilian intervention for HIV prevention in the severely mentally ill, the feasibility of which has been successfully evaluated in the pilot phase.