Abstract The study aimed to estimate the prevalence of alcohol use disorder (AUD) and associated factors in Brazilian adults that reported chronic noncommunicable diseases (NCDs), mental disorders (MDs), and infectious diseases (IDs). This was a secondary analysis of the 3rd National Survey on Drug Use by the Brazilian Population in which the principal outcome was presence of AUD. Prevalence of AUD was estimated for three subgroups: individuals that reported NCDs, MDs, and IDs. Factors associated with AUD in each group were analyzed using logistic regression models. Of the 15,645 adults interviewed, 30.5% (95%CI: 29.4-31.5) reported NCDs, 17.6% (95%CI: 16.5-18.7) MDs, and 1.6% (95%CI: 1.2-1.9) IDs. Considering comorbidities, the analytical sample was 6,612. No statistically significant difference was found in the prevalence of AUD between individuals with NCDs (7.5% [95%CI: 6.1- 8.7]), MDs (8.4% [95%CI: 6.7-10.2]), and IDs (12.4% [95%CI: 7.0-17.8]). The main factors associated with AUD in all the groups were male sex and young adult age. Considering the high prevalence of AUD in all the groups, systematic screening of AUD is necessary in health services that treat NCDs, MDs, and IDs.

Resumo O objetivo do artigo é estimar a prevalência de transtornos relacionados ao uso de álcool (TRA) e fatores associados entre indivíduos da população brasileira que reportaram doenças crônicas não-transmissíveis (DCNT), transtornos mentais (TM) e doenças infeciosas (DI). Análise secundária do III Levantamento Nacional sobre o Uso de Drogas pela População Brasileira, cujo desfecho principal foi a presença de TRA. A prevalência de TRA foi estimada para três subgrupos: indivíduos que reportaram DCNT, TM e DI. Os fatores associados a TRA dentro de cada grupo foram analisados utilizando modelos de regressão logística. Dos 15.645 adultos entrevistados, 30,5% (IC95%: 29,4-31,5) reportaram DCNT, 17,6% (IC95%: 16,5-18,7) TM e 1,6% (IC95%: 1,2-1,9) DI. Considerando as comorbidades, a amostra analítica foi de 6.612. Não foi encontrada diferença estatisticamente significativa na prevalência de TRA entre indivíduos com DCNT (7,5% [IC95% 6,1-8,7]), TM (8,4% [IC95% 6,7-10,2]) e DI (12,4% [IC95% 7,0-17,8]). Os principais fatores associados a TRA, em todos os grupos, foram ser do sexo masculino e jovem. Considerando a alta prevalência de TRA em todos os grupos é necessário seu rastreio sistemático em serviços de saúde que atendam DCNT, TM e DI.

Resumo O objetivo do artigo é estimar a prevalência de transtornos relacionados ao uso de álcool (TRA) e fatores associados entre indivíduos da população brasileira que reportaram doenças crônicas não-transmissíveis (DCNT), transtornos mentais (TM) e doenças infeciosas (DI). Análise secundária do III Levantamento Nacional sobre o Uso de Drogas pela População Brasileira, cujo desfecho principal foi a presença de TRA. A prevalência de TRA foi estimada para três subgrupos: indivíduos que reportaram DCNT, TM e DI. Os fatores associados a TRA dentro de cada grupo foram analisados utilizando modelos de regressão logística. Dos 15.645 adultos entrevistados, 30,5% (IC95%: 29,4-31,5) reportaram DCNT, 17,6% (IC95%: 16,5-18,7) TM e 1,6% (IC95%: 1,2-1,9) DI. Considerando as comorbidades, a amostra analítica foi de 6.612. Não foi encontrada diferença estatisticamente significativa na prevalência de TRA entre indivíduos com DCNT (7,5% [IC95% 6,1-8,7]), TM (8,4% [IC95% 6,7-10,2]) e DI (12,4% [IC95% 7,0-17,8]). Os principais fatores associados a TRA, em todos os grupos, foram ser do sexo masculino e jovem. Considerando a alta prevalência de TRA em todos os grupos é necessário seu rastreio sistemático em serviços de saúde que atendam DCNT, TM e DI. (TRA nãotransmissíveis não transmissíveis , (DCNT) (TM . (DI) Brasileira subgrupos logística 15645 15 645 15.64 entrevistados 305 30 5 30,5 IC95% IC95 IC (IC95% 29,431,5 294315 29,4 31,5 29 4 31 29,4-31,5 176 17 6 17,6 16,518,7 165187 16,5 18,7 16 18 7 16,5-18,7 1 1,6 1,21,9 1219 1,2 1,9 2 9 1,2-1,9 comorbidades 6612 612 6.612 7,5% 75 (7,5 [IC95 6,18,7, 6187 6,1 8,7 8 6,1-8,7]) 8,4% 84 (8,4 6,710,2 67102 6,7 10,2 10 6,7-10,2] 12,4% 124 12 (12,4 7,017,8. 70178 7,0 17,8 0 7,0-17,8]) jovem (DCNT (DI 1564 64 15.6 3 30, IC9 (IC95 431 29,431, 29431 294 29, 315 31, 29,4-31, 17, 518 16,518, 16518 165 16, 187 18, 16,5-18, 1, 21 1,21, 121 19 1,2-1, 661 61 6.61 7,5 (7, [IC9 6,18,7 618 6, 87 8, 6,1-8,7] 8,4 (8, 710 6,710, 6710 67 102 10, 6,7-10,2 12,4 (12, 017 7,017,8 7017 70 7, 178 7,0-17,8] 156 15. (IC9 43 29,431 2943 29,4-31 51 16,518 1651 16,5-18 1,21 1,2-1 66 6.6 (7 [IC 6,18, 6,1-8,7 (8 71 6,710 671 6,7-10, 12, (12 01 7,017, 701 7,0-17,8 (IC 29,43 29,4-3 16,51 16,5-1 1,2- 6. ( 6,18 6,1-8, 6,71 6,7-10 (1 7,017 7,0-17, 29,4- 16,5- 6,1-8 6,7-1 7,01 7,0-17 6,1- 6,7- 7,0-1 7,0-

Abstract The study aimed to estimate the prevalence of alcohol use disorder (AUD) and associated factors in Brazilian adults that reported chronic noncommunicable diseases (NCDs), mental disorders (MDs), and infectious diseases (IDs). This was a secondary analysis of the 3rd National Survey on Drug Use by the Brazilian Population in which the principal outcome was presence of AUD. Prevalence of AUD was estimated for three subgroups: individuals that reported NCDs, MDs, and IDs. Factors associated with AUD in each group were analyzed using logistic regression models. Of the 15,645 adults interviewed, 30.5% (95%CI: 29.4-31.5) reported NCDs, 17.6% (95%CI: 16.5-18.7) MDs, and 1.6% (95%CI: 1.2-1.9) IDs. Considering comorbidities, the analytical sample was 6,612. No statistically significant difference was found in the prevalence of AUD between individuals with NCDs (7.5% [95%CI: 6.1- 8.7]), MDs (8.4% [95%CI: 6.7-10.2]), and IDs (12.4% [95%CI: 7.0-17.8]). The main factors associated with AUD in all the groups were male sex and young adult age. Considering the high prevalence of AUD in all the groups, systematic screening of AUD is necessary in health services that treat NCDs, MDs, and IDs. (AUD , (NCDs) (MDs) . (IDs) rd subgroups models 15645 15 645 15,64 interviewed 305 30 5 30.5 95%CI 95CI CI 95 (95%CI 29.431.5 294315 29.4 31.5 29 4 31 29.4-31.5 176 17 6 17.6 16.518.7 165187 16.5 18.7 16 18 7 16.5-18.7 1 1.6 1.21.9 1219 1.2 1.9 2 9 1.2-1.9 comorbidities 6612 612 6,612 7.5% 75 (7.5 [95%CI 6.1 61 8.7, 87 8.7 8 8.7]) 8.4% 84 (8.4 6.710.2, 67102 6.7 10.2 10 6.7-10.2]) 12.4% 124 12 (12.4 7.017.8. 70178 7.0 17.8 0 7.0-17.8]) age (NCDs (MDs (IDs 1564 64 15,6 3 30. 431 29.431. 29431 294 29. 315 31. 29.4-31. 17. 518 16.518. 16518 165 16. 187 18. 16.5-18. 1. 21 1.21. 121 19 1.2-1. 661 6,61 7.5 (7. 6. 8. 8.7] 8.4 (8. 710 6.710.2 6710 67 102 10. 6.7-10.2] 12.4 (12. 017 7.017.8 7017 70 7. 178 7.0-17.8] 156 15, 43 29.431 2943 29.4-31 51 16.518 1651 16.5-18 1.21 1.2-1 66 6,6 (7 (8 71 6.710. 671 6.7-10.2 12. (12 01 7.017. 701 7.0-17.8 29.43 29.4-3 16.51 16.5-1 1.2- 6, ( 6.710 6.7-10. (1 7.017 7.0-17. 29.4- 16.5- 6.71 6.7-10 7.01 7.0-17 6.7-1 7.0-1 6.7- 7.0-

This is the second part of the Brazilian S20 mental health report. The mental health working group is dedicated to leveraging scientific insights to foster innovation and propose actionable recommendations for implementation in Brazil and participating countries. In addressing the heightened mental health challenges in a post-pandemic world, strategies should encompass several key elements. This second part of the S20 Brazilian Mental Health Report will delve into some of these elements, including: the impact of climate change on mental health, the influence of environmental factors on neurodevelopmental disorders, the intersection of serious mental illness and precision psychiatry, the co-occurrence of physical and mental disorders, advancements in biomarkers for mental disorders, the use of digital health in mental health care, the implementation of interventional psychiatry, and the design of innovative mental health systems that integrate principles of innovation and human rights. Reassessing the treatment settings for psychiatric patients in general hospitals, where their mental health and physical needs are addressed, should be prioritized in mental health policy. As the S20 countries prepare for the future, we need principles that can advance innovation, uphold human rights, and strive for the highest standards in mental health care. S S2 report postpandemic post pandemic world elements including disorders psychiatry cooccurrence co occurrence care rights hospitals addressed policy future

ABSTRACT Syndemic psychosocial and reproductive factors affecting women’s retention in HIV care remain understudied. We analyzed correlates of non-retention in a cohort of women with HIV in Brazil from 2000–2015. Participants self-reported exposure to physical/sexual violence, illicit drug use, adolescent pregnancy, or induced abortion. Lifetime history of these psychosocial stressors were used to create a syndemic score based on the presence or absence of these conditions. All dichotomous variables were summed (range 0 to 4), with greater scores indicating more syndemic factors experienced. Logistic regression models identified predictors of non-retention, defined as < 2 HIV viral load or CD4 results within the first year of enrollment. Of 915 women, non-retention was observed for 18%. Prevalence of syndemic factors was adolescent pregnancy (53.2%), physical/sexual violence (38.3%), induced abortion (27.3%), and illicit drug use (17.2%); 41.2% experienced > 2 syndemic conditions. Syndemic scores of 2 and 3 were associated with non-retention, as well as low education, years with HIV and seroprevalent syphilis. Psychosocial and reproductive syndemics can limit women’s retention in HIV care. Syphilis infection predicted non-retention and could be explored as a syndemic factor in future studies. womens s understudied nonretention non 20002015 2000 2015 2000–2015 selfreported self reported physicalsexual physical sexual conditions range 4, 4 , 4) nonretention, retention, CD enrollment 91 18 18% 53.2%, 532 53.2% 53 (53.2%) 38.3%, 383 38.3% 38 (38.3%) 27.3%, 273 27.3% 27 (27.3%) 17.2% 172 17 (17.2%) 412 41 41.2 education syphilis studies 2000201 200 201 2000–201 9 1 53.2 5 (53.2% 38.3 (38.3% 27.3 (27.3% 17.2 (17.2% 41. 200020 20 2000–20 53. (53.2 38. (38.3 27. (27.3 17. (17.2 20002 2000–2 (53. (38. (27. (17. 2000– (53 (38 (27 (17 (5 (3 (2 (1 (

ABSTRACT OBJECTIVE To evaluate the support of the Brazilian population to the alcohol-policies proposed by the World Health Organization to decrease alcohol harm (specifically: to decrease alcohol availability and advertising, and to increase pricing). In addition, we evaluated the factors associated with being against those policies. METHODS Data from 16,273 Brazilians, aged 12–65 years, interviewed in the 3rd Brazilian Household Survey on Substance Use (BHSU-3) were analyzed. The BHSU-3 is a nationwide, probability survey conducted in 2015. Individuals were asked if they would be against, neutral, or in favor of seven alcohol policies grouped as: 1) Strengthen restrictions on alcohol availability; 2) Enforce bans or restrictions on alcohol advertising, sponsorship, and promotion; and 3) Raise prices on alcohol through excise taxes and pricing. Generalized linear models were fitted to evaluate factors associated with being against each one of those policies and against all of policies. RESULTS Overall, 28% of the Brazilians supported all the above mentioned policies, whereas 16% were against them. The highest rate of approval refers to restricting advertising (53%), the lowest refers to increasing prices (40%). Factors associated with being against all policies were: being male (AOR = 1.1; 95%CI: 1.0–1.3), not having a religion (AOR = 1.4; 95%CI: 1.1–1.8), being catholic (AOR = 1.3; 95%CI: 1.1–1.5), and alcohol dependence (AOR = 1.6; 95%CI: 1.1–2.4). CONCLUSIONS The Brazilian government could count on the support of most of the population to restrict alcohol advertising. This information is essential to tackle the lobby of the alcohol industry and its clever marketing strategy.

ABSTRACT OBJECTIVE To evaluate the support of the Brazilian population to the alcohol-policies proposed by the World Health Organization to decrease alcohol harm (specifically: to decrease alcohol availability and advertising, and to increase pricing). In addition, we evaluated the factors associated with being against those policies. METHODS Data from 16,273 Brazilians, aged 12–65 years, interviewed in the 3rd Brazilian Household Survey on Substance Use (BHSU-3) were analyzed. The BHSU-3 is a nationwide, probability survey conducted in 2015. Individuals were asked if they would be against, neutral, or in favor of seven alcohol policies grouped as: 1) Strengthen restrictions on alcohol availability; 2) Enforce bans or restrictions on alcohol advertising, sponsorship, and promotion; and 3) Raise prices on alcohol through excise taxes and pricing. Generalized linear models were fitted to evaluate factors associated with being against each one of those policies and against all of policies. RESULTS Overall, 28% of the Brazilians supported all the above mentioned policies, whereas 16% were against them. The highest rate of approval refers to restricting advertising (53%), the lowest refers to increasing prices (40%). Factors associated with being against all policies were: being male (AOR = 1.1; 95%CI: 1.0–1.3), not having a religion (AOR = 1.4; 95%CI: 1.1–1.8), being catholic (AOR = 1.3; 95%CI: 1.1–1.5), and alcohol dependence (AOR = 1.6; 95%CI: 1.1–2.4). CONCLUSIONS The Brazilian government could count on the support of most of the population to restrict alcohol advertising. This information is essential to tackle the lobby of the alcohol industry and its clever marketing strategy.

Abstract Introduction Recent research has suggested an increase in the global prevalence of psychiatric symptoms during the COVID-19 pandemic. This study aimed to assess whether lifestyle behaviors can predict the presence of depression and anxiety in the Brazilian general population, using a model developed in Spain. Methods A web survey was conducted during April-May 2020, which included the Short Multidimensional Inventory Lifestyle Evaluation (SMILE) scale, assessing lifestyle behaviors during the COVID-19 pandemic. Depression and anxiety were examined using the PHQ-2 and the GAD-7, respectively. Elastic net, random forest, and gradient tree boosting were used to develop predictive models. Each technique used a subset of the Spanish sample to train the models, which were then tested internally (vs. the remainder of the Spanish sample) and externally (vs. the full Brazilian sample), evaluating their effectiveness. Results The study sample included 22,562 individuals (19,069 from Brazil, and 3,493 from Spain). The models developed performed similarly and were equally effective in predicting depression and anxiety in both tests, with internal test AUC-ROC values of 0.85 (depression) and 0.86 (anxiety), and external test AUC-ROC values of 0.85 (depression) and 0.84 (anxiety). Meaning of life was the strongest predictor of depression, while sleep quality was the strongest predictor of anxiety during the COVID-19 epidemic. Conclusions Specific lifestyle behaviors during the early COVID-19 epidemic successfully predicted the presence of depression and anxiety in a large Brazilian sample using machine learning models developed on a Spanish sample. Targeted interventions focused on promoting healthier lifestyles are encouraged.

Objective: To evaluate satisfaction and burden of mental health personnel providing mental health services for substance users and their families. Method: Five hundred twenty-seven mental health workers who provide treatment for substance users in five Brazilian states were interviewed. Data on sociodemographic characteristics and measures of satisfaction (SATIS-BR) and burden of mental health personnel (IMPACTO-BR) were collected. Results: Type of mental health service and educational attainment were associated with degree of satisfaction and burden. Therapeutic community workers and those with a primary education level reported being more satisfied with the treatment offered to patients, their engagement in service activities, and working conditions. Workers from psychosocial care centers, psychosocial care centers focused on alcohol and other drugs, and social care referral centers (both general and specialized), as well as workers with a higher education, reported feeling overburdened. Conclusion: This study offers important information regarding the relationship of mental health personnel with their work. Care providers within this sample reported an overall high level of job satisfaction, while perceived burden differed by type of service and educational attainment. To our knowledge, this is the first study with a sample of mental health professionals working with substance users across five Brazilian states.

Objective: In an attempt to reduce high levels of traffic crashes, a new legislation was approved in Brazil in 2008. This study aimed to assess behavioral change among drivers who had drunk at alcohol outlets (AO) after implementation of the law. Method: A three-stage probability sampling survey was conducted in Porto Alegre, state of Rio Grande do Sul, Brazil. Individuals seen leaving AOs after drinking were approached (n=3,018). Selected drivers (n=683) answered a structured interview, were breathalyzed, and had saliva specimens collected for drug screening. Results: Overall, 60.3% (SE 4.5) of drivers reported they did not change their behavior. Among those who reported behavioral changes, most reported drinking less as their main strategy toward safer driving behavior. Variables independently associated with behavior change included having drunk at a high outlet density area (odds ratio [OR] 1.7 [1.1-2.8]) and having a favorable opinion about the law (OR 4.3 [2.1-8.9]). Conclusions: Our findings suggest that awareness of the law has not been enough to promote behavioral change. As most drivers had a favorable opinion of the law and this variable was found to be the strongest predictor of behavior change, efforts to better integrate education and enforcement seem to be pivotal and might be well received by the population.