Abstract This study evaluated the prevalence of positive screening for depression in Brazil and its associated factors. We used data from National Health Survey 2019 (Pesquisa Nacional de Saúde - PNS), a population-based survey with 88,531 adults. The Patient Health Questionnaire (PHQ-9) was used with two scoring methods, the algorithm and the cutoff point≥10. The variables included sociodemographic characteristics. The prevalence ratios and 95% confidence intervals (95%CI) were estimated using Poisson regression. The positive screening for depression was 10.8% (95%CI: 10.4-11.0), at the cutoff point ≥10 and 5.7% (95%CI: 5.4-6.0) for algorithm. Significant differences were found in prevalence in some Brazilian states. Multivariable analyses showed that being female, black, under 70 years of age, having little education, being single, and living in an urban area were independently associated with a depressive symptoms. The highest association was found in the states of Sergipe, Goiás, Piauí, Espírito Santo, São Paulo, Alagoas and lowest in Pará, Mato Grosso and Maranhão. The prevalence of positive screening for depression in Brazil has increased in recent years. More investment in mental health resources is necessary and surveys such as the PNS should be continued. factors 201 Pesquisa PNS, , PNS) populationbased population based 88531 88 531 88,53 adults PHQ9 PHQ 9 (PHQ-9 methods point10 10 point≥10 characteristics 95 95%CI 95CI CI (95%CI regression 108 8 10.8 10.411.0, 104110 10.4 11.0 4 11 0 10.4-11.0) ≥1 57 5 7 5.7 5.46.0 5460 5.4 6.0 6 5.4-6.0 female black age education single symptoms Sergipe Goiás Piauí Santo Paulo Pará Maranhão continued 20 8853 53 88,5 (PHQ- point1 1 point≥1 10. 411 10.411.0 10411 104 110 11. 10.4-11.0 ≥ 5. 46 5.46. 546 54 60 6. 5.4-6. 2 885 88, (PHQ point≥ 41 10.411. 1041 10.4-11. 5.46 5.4-6 10.411 10.4-11 5.4- 10.41 10.4-1 10.4-

Resumo Este estudo avaliou a prevalência de triagem positiva para depressão no Brasil e seus fatores associados. Utilizou-se dados da Pesquisa Nacional de Saúde 2019 (PNS), um inquérito de base populacional com 88.531 adultos. Para avaliar os sintomas depressivos utilizou-se o Patient Health Questionnaire (PHQ-9) com dois métodos de pontuação: o algoritmo e o ponto de corte ≥10. As variáveis incluíram características sociodemográficas. Utilizou-se a regressão de Poisson para obter razões de prevalência, com intervalo de confiança de 95% (IC95%). A triagem positiva para depressão foi de 10,8% (IC95%: 10,4-11,0), no ponto de corte ≥10 e 5,7% (IC95%: 5,4-6,0) para o algoritmo. Houve diferenças significativas na prevalência entre alguns estados brasileiros. Análises multivariadas mostraram que ser do sexo feminino, negro, ter menos de 70 anos, ter baixa escolaridade, ser solteiro e residir em área urbana estiveram independentemente associados a sintomas depressivos. A maior associação foi encontrada nos estados de Sergipe, Goiás, Piauí, Espírito Santo, São Paulo, Alagoas e a menor no Pará, Mato Grosso e Maranhão. A prevalência de triagem positiva para depressão no Brasil tem aumentado nos últimos anos. É necessário mais investimento em saúde mental e pesquisas como a PNS devem ser feitas continuamente. Utilizouse Utilizou se 201 PNS, , (PNS) 88531 88 531 88.53 adultos utilizouse utilizou PHQ9 PHQ 9 (PHQ-9 pontuação 10 sociodemográficas 95 IC95%. IC95 IC IC95% . (IC95%) 108 8 10,8 (IC95% 10,411,0, 104110 10,4 11,0 4 11 0 10,4-11,0) ≥1 57 5 7 5,7 5,46,0 5460 5,4 6,0 6 5,4-6,0 brasileiros feminino negro anos escolaridade Sergipe Goiás Piauí Santo Paulo Pará Maranhão continuamente 20 (PNS 8853 53 88.5 (PHQ- 1 IC9 10, (IC95 411 10,411,0 10411 104 110 11, 10,4-11,0 ≥ 5, 46 5,46, 546 54 60 6, 5,4-6, 2 885 88. (PHQ (IC9 41 10,411, 1041 10,4-11, 5,46 5,4-6 (IC 10,411 10,4-11 5,4- 10,41 10,4-1 10,4-

Abstract This study evaluated the prevalence of positive screening for depression in Brazil and its associated factors. We used data from National Health Survey 2019 (Pesquisa Nacional de Saúde - PNS), a population-based survey with 88,531 adults. The Patient Health Questionnaire (PHQ-9) was used with two scoring methods, the algorithm and the cutoff point≥10. The variables included sociodemographic characteristics. The prevalence ratios and 95% confidence intervals (95%CI) were estimated using Poisson regression. The positive screening for depression was 10.8% (95%CI: 10.4-11.0), at the cutoff point ≥10 and 5.7% (95%CI: 5.4-6.0) for algorithm. Significant differences were found in prevalence in some Brazilian states. Multivariable analyses showed that being female, black, under 70 years of age, having little education, being single, and living in an urban area were independently associated with a depressive symptoms. The highest association was found in the states of Sergipe, Goiás, Piauí, Espírito Santo, São Paulo, Alagoas and lowest in Pará, Mato Grosso and Maranhão. The prevalence of positive screening for depression in Brazil has increased in recent years. More investment in mental health resources is necessary and surveys such as the PNS should be continued.

Resumo Este estudo avaliou a prevalência de triagem positiva para depressão no Brasil e seus fatores associados. Utilizou-se dados da Pesquisa Nacional de Saúde 2019 (PNS), um inquérito de base populacional com 88.531 adultos. Para avaliar os sintomas depressivos utilizou-se o Patient Health Questionnaire (PHQ-9) com dois métodos de pontuação: o algoritmo e o ponto de corte ≥10. As variáveis incluíram características sociodemográficas. Utilizou-se a regressão de Poisson para obter razões de prevalência, com intervalo de confiança de 95% (IC95%). A triagem positiva para depressão foi de 10,8% (IC95%: 10,4-11,0), no ponto de corte ≥10 e 5,7% (IC95%: 5,4-6,0) para o algoritmo. Houve diferenças significativas na prevalência entre alguns estados brasileiros. Análises multivariadas mostraram que ser do sexo feminino, negro, ter menos de 70 anos, ter baixa escolaridade, ser solteiro e residir em área urbana estiveram independentemente associados a sintomas depressivos. A maior associação foi encontrada nos estados de Sergipe, Goiás, Piauí, Espírito Santo, São Paulo, Alagoas e a menor no Pará, Mato Grosso e Maranhão. A prevalência de triagem positiva para depressão no Brasil tem aumentado nos últimos anos. É necessário mais investimento em saúde mental e pesquisas como a PNS devem ser feitas continuamente.

Abstract INTRODUCTION: Older adults present a higher risk of suicide, and Brazil is experiencing a fast population aging. To understand the impact of demographic transition, we compared Brazilian suicide mortality rates (MR) among adults (50+ years) with global rates, those from one high-income country, and those from one middle-income country. Looking for regional disparities, the MR was analyzed among older adults (60+ years) by Brazilian states. METHODS: This was an ecological study based on estimates from the Global Burden of Disease Study, from 2000 to 2019. Age-standardized MR and age-specific MR per 100,000 inhabitants were described, with 95% uncertainty intervals (UI). RESULTS: During the period, the annual estimates and the declining trend in mortality were higher in the world than in the studied countries. In 2019, global age-standardized MR was 9.39 (95% UI 8.48-10.29), compared to 5.68 (95% UI 5.40-6.19), 6.01 (95% UI 5.10-7.04), and 6.63 (95% UI 6.43-6.95) in Brazil, Mexico, and England, respectively. In Brazil, despite a significant decline in national rates, stability was observed in 15 states. An increase in aging was only found for men, who presented 3-4 times higher MR than women. The states’ rates presented large differences: in 2019, the rates among men aged 60-64 years varied from 7.24 (95% UI 5.31; 9.85) to 26.32 (95% UI 20.21; 34.50). CONCLUSIONS: The smaller decline in suicide mortality among older Brazilian adults, the increasing risk with aging, and the higher mortality among men indicate the need for specific prevention policies. The variation within states suggests differences in the data quality or in socio-cultural and historical aspects, which requires further investigation.

Abstract INTRODUCTION: Pancreatic cancer is increasing worldwide. The burden of pancreatic cancer in Brazil and its states was analyzed and compared with that from the USA and China. METHODS: This is a descriptive study of the incidence and mortality estimates from the Global Burden of Disease 2019 study, from 2000 to 2019. The Brazilian states presenting the highest and lowest socio-demographic index (SDI) were selected from each of the five regions. The SDI consists of the per capita income, education, and fertility rate of each population. RESULTS: A significant increase was found in age-standardized incidence and mortality of pancreatic cancer in all three countries, with differences in magnitude and annual increases. In Brazil, this incidence rose from 5.33 [95% Uncertainty Interval (UI): 5.06- 5.51] to 6.16 (95% UI: 5.68- 6.53) per 100,000 inhabitants. China and the Brazilian states with the lowest SDI, such as Pará and Maranhão, showed lower incidence and mortality rates, although presenting the highest annual increases. No difference was found between the sexes. A higher mortality rate was observed for those individuals of 70+ years, which was three to four times higher than those aged 50 to 69 years. CONCLUSIONS: The increasing burden of pancreatic cancer in the studied countries, and the higher estimates for the elderly in a fast-aging country such as Brazil, indicates that more resources and health policies will be necessary. The greatest increase in the states with lower SDI reflects inequalities in the access to diagnosis and registries of this cancer.

Abstract INTRODUCTION: Brazil is an important consumer market for cocaine. However, the consequences of this consumption and the pattern of distribution of the estimates are still poorly studied in the Brazilian states. The Global Burden of Disease study - 2019 (GBD-2019) has enabled us to describe and analyze indicators of mental disorders (MD) attributable by cocaine use in Brazil and its states, in 1990 and 2019. METHODS: A descriptive study of the burden of cocaine use disorders, using prevalence, age-standardized mortality rate (ASMR), years of life lost (YLL) due to premature death, years lived with disabilities (YLD), and disability adjusted life years (DALY), which accounts for YLL+YLD. RESULTS: Brazil ranks 8th as DALYs due to cocaine use disorder in the world (42.83/100.000; 95% uncertainty intervals [95% UI]: 35.28 to 61.43). Significant increases have occurred in the age-standardized rate prevalence (ASRP), ASMR, DALY, YLD, and YLL, in Brazil and its states, between 1990 and 2019. The ASRP in 2019 was 2.7-fold higher for men (278.60/100.000; 95% UI: 208.20 to 374.39) in comparison to women (104.01/100.000; 95% UI: 76.70 to 143.02). There is a predominance of YLD in the composition of DALYs; however, the YLL had the biggest increases between 1990 and 2019. CONCLUSIONS: The high rate of DALYs and the increase in mortality rates show the need to scale up effective interventions to prevent and reduce the burden of disease attributable to cocaine use disorder, which is a preventable cause of death and disability.

Abstract INTRODUCTION: Suicide deaths varies according to location, sex, and age. This study analyzed the Global Burden of Disease Study 2019 (GBD 2019) concerning suicide in Brazil. METHODS: This study described the mortality and years of life lost (YLL) due to premature death caused by suicide in Brazil in 1990 and 2019. The numbers, crude and age-standardized mortality rate (ASMR), and YLL were compared among Brazilian states, age groups, and sexes. RESULTS: There were 13,502 suicides in Brazil in 2019, 46.00% more than in 1990. The crude mortality rate increased 0.32%, while the ASMR declined -21.68% during the period. Crude and age-standardized YLL rates declined by -7.24% and -18.38%, respectively. In 2019, the biggest ASMRs were found in the South, whereas from 1990 to 2019, the ASMR declined in the South, Southeast, and Midwest, and increased in the Northeast. The number of suicides was higher among individuals aged 15-49 years, and suicide rates were higher among those aged over 70 years. From 1990 to 2019, an increase in the rate was found only of 10-14 years of age. Suicide was highest in men, except in the 10-14-year age group, ranking third in mortality among men of 15-34 years of age and fourth among women of 15-24 years of age. CONCLUSIONS: The ASMR and YLL for suicide declined since 1990, but suicide remains an important factor of mortality in the country. The South Region, men, elderly, and youth should be priorities in the implementation of suicide prevention strategies in Brazil.

RESUMO OBJETIVO Caracterizar o perfil dos pacientes que foram internados por transtornos mentais e comportamentais pelo Sistema Único de Saúde (SUS) no Brasil entre 2000 e 2014, bem como verificar como aspectos da nova política de saúde mental influenciaram a taxa de pacientes internados no referido período. MÉTODOS Estudo de coorte prospectiva não concorrente utilizando dados secundários de pacientes internados com diagnóstico primário de transtornos mentais e comportamentais entre 01/01/2000 e 31/12/2014. Foram selecionadas variáveis sociodemográficas, clínicas e de características do hospital, além disso, foram calculadas as taxas gerais de pacientes internados segundo motivo de internação, tipo de hospital, natureza jurídica e número de internações de cada paciente por ano. Foi testada a associação entre taxas de pacientes internados, número de leitos psiquiátricos por ano e número de Centros de Atenção Psicossocial por ano. RESULTADOS Foram selecionados 1.549.298 pacientes dos quais os diagnósticos mais frequentes na primeira internação foram os transtornos devidos ao uso de substâncias psicoativas, seguidos por esquizofrenia e transtornos de humor. A mediana de internações por paciente foi de 1,9 e a de tempo de internação por paciente foi de 29 dias. A taxa geral de pacientes internados foi reduzida à quase metade no período. O número de leitos por ano apresentou associação positiva com as taxas de pacientes internados, e o número de CAPS por ano teve associação negativa com algumas taxas de pacientes internados. CONCLUSÃO Verificou-se que, mesmo diante de um contexto de adversidades, a Política Nacional de Saúde Mental avançou em suas metas de reduzir progressivamente os leitos hospitalares e aumentar a oferta de serviços substitutivos de tal modo que ambas as estratégias foram associadas à redução das taxas de pacientes internados. Contudo, as mudanças foram percebidas com maior intensidade nos primeiros anos de implantação da política, tornando-se menos pujante nos últimos anos.

ABSTRACT OBJECTIVE To characterize the profile of patients hospitalized for mental and behavioral disorders by the Unified Health System (SUS) in Brazil between 2000 and 2014, and to verify how aspects of the new mental health policy influenced the rate of hospitalized patients in that period. METHODS Non-concurrent prospective cohort study using secondary data from inpatients with a primary diagnosis of mental and behavioral disorders between 01/01/2000 and 12/31/2014. Sociodemographic, clinical, and hospital characteristics variables were selected. Overall rates of hospitalized patients were calculated according to reason for admission, type of hospital, legal nature, and number of admissions per year for each patient. The association between rates of hospitalized patients, number of psychiatric beds per year, and number of Psychosocial Care Centers per year were tested. RESULTS We selected a total of 1,549,298 patients, whose most frequent diagnoses on first admission were psychoactive substance use disorders, followed by schizophrenia and mood disorders. The median of hospitalizations per patient was 1.9 and the length of stay per patient was 29 days. The overall rate of hospitalized patients was reduced by almost half in the period. The number of beds per year was positively associated with the rates of hospitalized patients; the number of CAPS per year was negatively associated with some rates of hospitalized patients. CONCLUSION Even in the face of adversity, the National Mental Health Policy has advanced in its goal of progressively reducing hospital beds and increasing the supply of substitute services such that both strategies were associated with the reduced inpatient rates. But the changes were felt with greater intensity in the first years of the policy’s implementation, becoming less pronounced in recent years.

RESUMO OBJETIVO Caracterizar o perfil dos pacientes que foram internados por transtornos mentais e comportamentais pelo Sistema Único de Saúde (SUS) no Brasil entre 2000 e 2014, bem como verificar como aspectos da nova política de saúde mental influenciaram a taxa de pacientes internados no referido período. MÉTODOS Estudo de coorte prospectiva não concorrente utilizando dados secundários de pacientes internados com diagnóstico primário de transtornos mentais e comportamentais entre 01/01/2000 e 31/12/2014. Foram selecionadas variáveis sociodemográficas, clínicas e de características do hospital, além disso, foram calculadas as taxas gerais de pacientes internados segundo motivo de internação, tipo de hospital, natureza jurídica e número de internações de cada paciente por ano. Foi testada a associação entre taxas de pacientes internados, número de leitos psiquiátricos por ano e número de Centros de Atenção Psicossocial por ano. RESULTADOS Foram selecionados 1.549.298 pacientes dos quais os diagnósticos mais frequentes na primeira internação foram os transtornos devidos ao uso de substâncias psicoativas, seguidos por esquizofrenia e transtornos de humor. A mediana de internações por paciente foi de 1,9 e a de tempo de internação por paciente foi de 29 dias. A taxa geral de pacientes internados foi reduzida à quase metade no período. O número de leitos por ano apresentou associação positiva com as taxas de pacientes internados, e o número de CAPS por ano teve associação negativa com algumas taxas de pacientes internados. CONCLUSÃO Verificou-se que, mesmo diante de um contexto de adversidades, a Política Nacional de Saúde Mental avançou em suas metas de reduzir progressivamente os leitos hospitalares e aumentar a oferta de serviços substitutivos de tal modo que ambas as estratégias foram associadas à redução das taxas de pacientes internados. Contudo, as mudanças foram percebidas com maior intensidade nos primeiros anos de implantação da política, tornando-se menos pujante nos últimos anos.

ABSTRACT OBJECTIVE To characterize the profile of patients hospitalized for mental and behavioral disorders by the Unified Health System (SUS) in Brazil between 2000 and 2014, and to verify how aspects of the new mental health policy influenced the rate of hospitalized patients in that period. METHODS Non-concurrent prospective cohort study using secondary data from inpatients with a primary diagnosis of mental and behavioral disorders between 01/01/2000 and 12/31/2014. Sociodemographic, clinical, and hospital characteristics variables were selected. Overall rates of hospitalized patients were calculated according to reason for admission, type of hospital, legal nature, and number of admissions per year for each patient. The association between rates of hospitalized patients, number of psychiatric beds per year, and number of Psychosocial Care Centers per year were tested. RESULTS We selected a total of 1,549,298 patients, whose most frequent diagnoses on first admission were psychoactive substance use disorders, followed by schizophrenia and mood disorders. The median of hospitalizations per patient was 1.9 and the length of stay per patient was 29 days. The overall rate of hospitalized patients was reduced by almost half in the period. The number of beds per year was positively associated with the rates of hospitalized patients; the number of CAPS per year was negatively associated with some rates of hospitalized patients. CONCLUSION Even in the face of adversity, the National Mental Health Policy has advanced in its goal of progressively reducing hospital beds and increasing the supply of substitute services such that both strategies were associated with the reduced inpatient rates. But the changes were felt with greater intensity in the first years of the policy’s implementation, becoming less pronounced in recent years.

Objective: To describe IHME projections for the COVID-19 pandemic in Brazil and its states and discuss their accuracy and implications for different scenarios. Methods: We describe and estimate the accuracy of these predictions for Brazil by comparing them with the ensuing reported cumulative deaths. Results: The pandemic is projected to cause 192,511 deaths by December 1, 2020. Continued relaxation of mandated physical isolation despite rising deaths could cause gt;63,000 additional deaths, while rapid increase in mask use could reduce the projected death toll by ~25,000. Several states will likely be obliged to reinstitute mandated restrictions.nbsp; Differences between IHME projections up to 6 weeks and recorded deaths ranged from -11% to 48% for Brazil. Conclusion: IHME short to medium term projections of deaths provide sufficiently accurate information to inform health planners, elected officials, and society. They suggest a prolonged pandemic course, with major mortality and probable necessity of renewed restrictions.

Objetivo: Describir las proyecciones del IHME para COVID-19 en Brasil y sus estados y discutir la precisión y las implicaciones en diferentes escenarios. Métodos: Describimos y estimamos la precisión de las previsiones para Brasil, comparándolos con las muertes acumuladas observadas. Resultados: La proyección predice 192.511 muertes por la pandemia al 1 de diciembre de 2020. La relajación continua del aislamiento físico obligatorio, a pesar del continuo aumento de muertes, puede causar gt;63.000 muertes adicionales; el rápido aumento en el uso de mascarillas puede reducir el número a ~25.000. Es posible que varios estados deban restablecer las restricciones. Las diferencias entre las proyecciones del IHME hasta las 6 semanas y las muertes registradas oscilaron entre -11% y 48% para Brasil. Conclusiones: Las proyecciones de corto a mediano plazo del IHME brindan información válida para informar a los administradores de salud, oficiales electos y la sociedad. Sugieren un curso prolongado, alta mortalidad y probablemente nuevas restricciones.

Objetivo: Descrever as projeções do IHME para a COVID-19 no Brasil e seus estados e discutir acurácia e implicações em diferentes cenários. Métodos: Descrevemos e estimamos a acurácia das previsões para o Brasil, comparando-as com as mortes cumulativas observadas. Resultados: A projeção prevê 192.511 mortes causadas pela pandemia até 1 de dezembro de 2020. O relaxamento continuado do isolamento físico obrigatório, apesar do aumento continuado dos óbitos, pode causar gt;63.000 mortes adicionais; o rápido aumento no uso de máscara pode reduzir o número para ~25.000. Vários estados poderão ter que reinstituir restrições. As diferenças entre as projeções do IHME até 6 semanas e as mortes registradas variaram de -11% a 48% para o Brasil. Conclusões: As projeções de curto a médio prazo do IHME fornecem informações válidas para informar os gestores de saúde, autoridades eleitas e a sociedade em geral. Elas sugerem curso prolongado, grande mortalidade e prováveis novas restrições.

The growth of tourism and its infrastructure has led to an increase in the amount of solidwaste, that provoke a negative environmental impact on these destinations. The Francês beach is located in the city of Marechal Deodoro (Brazil) and, despite having a large part of its income concentrated in the tourism sector, no study was carried out to evaluate the perception and management of solid waste generated by tourism in Francês beach. The objective of this paper was to identify the levels of knowledge about solid waste management, as well as the environmental management activities and the environmental perception of the managers of lodging of the French beach in Marechal Deodoro. The research had a qualitative and quantitative character, being carried out interviews with managers of the lodges, application of forms with structured and semistructured questions and the completion of the field diary. The sample had a non-probabilistic character for convenience and for definition of the same were established three criteria: registration in the Ministry of Tourism, means of lodging with a maximum of 30 housing units and interest in participating in the research. After the survey, 21 establishments were able to participate, however, two showed no interest. The forms were applied during the months of July and October 2017. Based on the results obtained, one can affirm that adequate management forms are still evident, because actions such as separation of garbage and training of employees on environmental issues have not yet been carried out for more than 70% of the enterprises surveyed. It is important to highlight that more than 80% of them do not have any policies to minimize the generation of waste in their enterprises. Therefore, there is a real need in the area for works focused on environmental education involving the entire tourism trade, so that a greater awareness of the environment for this sector is created.

El crecimiento del turismo y de la infraestructura turística ha aumentado la cantidad de residuos sólidos, generando un impacto ambiental negativo en los destinos. La Praia do Francês está localizada en el Municipio de Marechal Deodoro (Brasil) y a pesar de que la mayor parte de sus ingresos proviene del sector turístico, no se han evaluado la percepción y el manejo de los residuos sólidos generados por el turismo. Esta investigación busca identificar los niveles de conocimiento sobre la gestión de los residuos sólidos, la gestión ambiental y la percepción ambiental de los gestores de hospedajes en la Praia do Francês. Fue un estudio de carácter cualitativo y cuantitativo, con entrevistas a gestores de los hospedajes y un diario de campo. La muestra no probabilística por conveniencia siguió tres criterios: registro en el Ministerio de Turismo, hospedajes de no más de 30 unidades e interés por participar de la investigación. Los formularios fueron aplicados durante julio y octubre de 2017. Se puede afirmar que la separación de la basura y la capacitación de los empleados sobre temas ambientales, aún no han sido puestas en práctica por más del 70% de los emprendimientos estudiados. Es importante destacar que más del 80% no posee ninguna política para minimizar la generación de residuos en sus emprendimientos. Por lo tanto, existe en el área una necesidad real de trabajos volcados a la educación ambiental que involucren a todo el trade turístico, para despertar mayor consciencia sobre el ambiente en este sector.

Abstract Introduction The Patient Health Questionnaire (PHQ-9) is one of the most validated tools used to detect depressive episodes in Brazil. Objective This study investigates the psychometric properties of the PHQ-9 using the Item Response Theory. Method We used the gradual response model to assess depression in 764 residents of Brazilian rural communities of descended from slaves (quilombos) from the county of Vitória da Conquista, state of Bahia, Brazil, who had responded to PHQ-9. We estimated the parameters for item discrimination and difficulty. Results The items of the PHQ-9 showed the ability to discriminate from moderate to very high. The items evaluating thoughts of hurting oneself and death showed the greatest discrimination while feeling depressed showed the lowest discrimination. Discussion and conclusion The Item Response Theory enables advances in the analysis of the psychometric properties of the screening tools assessing depression, and indicates that PHQ-9 can be used in rural populations in Brazil.

Resumen Introducción El Cuestionario de Salud del Paciente (PHQ-9) es una de las escalas validadas de detección del episodio depresivo mayor más utilizada en Brasil. Objetivo Este estudio investiga las propiedades psicométricas de la PHQ-9 usando la Teoría de Respuesta de Ítem. Método Utilizamos el modelo de respuesta gradual para evaluar la depresión en 764 residentes en comunidades rurales brasileñas descendientes de esclavos (quilombos) del condado de Vitória da Conquista, estado de Bahía, Brasil, que habían respondido al PHQ-9. Estimamos los parámetros para la discriminación y la dificultad del ítem. Resultados Los ítems del PHQ-9 mostraron la capacidad de discriminar de moderado a muy alto. Los ítems que evaluaban los pensamientos de hacerse daño a sí mismo y la muerte mostraban la mayor discriminación, mientras que sentirse deprimido mostró la discriminación más baja. Discusión y conclusión La Teoría de Respuesta de Item permite avances en el análisis de las propiedades psicométricas de las herramientas de evalúan la depresión y permitió concluir que el PHQ-9 puede utilizarse en poblaciones rurales de Brasil.

Resumo Os pacientes psiquiátricos estão em risco aumentado de eventos adversos da vida, como ser preso e morar na rua. Investigamos a associação de características sociodemográficas, clínicas, comportamentais e eventos adversos de vida com o histórico de morar na rua, encarceramento e a coocorrência dessas duas condições ao longo da vida em um estudo multicêntrico de corte transversal de 2.475 usuários de 26 serviços de saúde mental no Brasil. “Odds ratios” foram obtidos por modelos de regressão logística multinomial. A prevalência de morar na rua, encarceramento e coocorrência dessas condições foi de 8,6%, 16,4% e 9,4%, respectivamente. Menor renda, viver em habitações instáveis, deficiência mental e tabagismo foram associados a morar na rua. Ser do sexo masculino, ter menor escolaridade, histórico de sexo sob efeito de álcool ou drogas e múltiplos parceiros sexuais foram associados ao encarceramento. Internações psiquiátricas, uso de substâncias, histórico de doenças sexualmente transmissíveis e violência sexual, física ou verbal foram associados à coocorrência das duas condições. Encarceramento e morar na rua são eventos muito prevalentes e correlacionados em pacientes psiquiátricos. Muitos dos fatores associados são modificáveis e podem agir sinergicamente exigindo cuidados integrados.

Abstract Psychiatric patients are at increased risk of adverse life events, such as being incarcerated and homelessness in their life course. Using data from a cross-sectional multicenter study of 2,475 patients selected from 26 mental health services in Brazil, we examined the association of sociodemographic, clinical, behavioral, and adverse life characteristics with history of homelessness, incarceration or their co-occurrence during lifetime. Odds ratios were obtained by multinomial logistic regression models. The prevalence of homelessness, incarceration and co-occurrence of these two conditions were 8.6%, 16.4%, and 9.4%, respectively. Lower income, living in unstable condition, intellectual disability, and cigarette smoking were associated with homelessness. Being male, lower schooling, sex under effect of alcohol or drugs, and multiple sex partners were associated with incarceration. Psychiatric hospitalizations, substance use, and history of sexually transmitted diseases, and sexual, physical, or verbal violence were associated with co-occurrence of both conditions. Our findings suggest that incarceration and homelessness are very prevalent and correlated in psychiatric patients in Brazil. Many of the associated factors are potentially modifiable, and may act synergistically requiring integrated care.

Resumo Os pacientes psiquiátricos estão em risco aumentado de eventos adversos da vida, como ser preso e morar na rua. Investigamos a associação de características sociodemográficas, clínicas, comportamentais e eventos adversos de vida com o histórico de morar na rua, encarceramento e a coocorrência dessas duas condições ao longo da vida em um estudo multicêntrico de corte transversal de 2.475 usuários de 26 serviços de saúde mental no Brasil. “Odds ratios” foram obtidos por modelos de regressão logística multinomial. A prevalência de morar na rua, encarceramento e coocorrência dessas condições foi de 8,6%, 16,4% e 9,4%, respectivamente. Menor renda, viver em habitações instáveis, deficiência mental e tabagismo foram associados a morar na rua. Ser do sexo masculino, ter menor escolaridade, histórico de sexo sob efeito de álcool ou drogas e múltiplos parceiros sexuais foram associados ao encarceramento. Internações psiquiátricas, uso de substâncias, histórico de doenças sexualmente transmissíveis e violência sexual, física ou verbal foram associados à coocorrência das duas condições. Encarceramento e morar na rua são eventos muito prevalentes e correlacionados em pacientes psiquiátricos. Muitos dos fatores associados são modificáveis e podem agir sinergicamente exigindo cuidados integrados.

Abstract Psychiatric patients are at increased risk of adverse life events, such as being incarcerated and homelessness in their life course. Using data from a cross-sectional multicenter study of 2,475 patients selected from 26 mental health services in Brazil, we examined the association of sociodemographic, clinical, behavioral, and adverse life characteristics with history of homelessness, incarceration or their co-occurrence during lifetime. Odds ratios were obtained by multinomial logistic regression models. The prevalence of homelessness, incarceration and co-occurrence of these two conditions were 8.6%, 16.4%, and 9.4%, respectively. Lower income, living in unstable condition, intellectual disability, and cigarette smoking were associated with homelessness. Being male, lower schooling, sex under effect of alcohol or drugs, and multiple sex partners were associated with incarceration. Psychiatric hospitalizations, substance use, and history of sexually transmitted diseases, and sexual, physical, or verbal violence were associated with co-occurrence of both conditions. Our findings suggest that incarceration and homelessness are very prevalent and correlated in psychiatric patients in Brazil. Many of the associated factors are potentially modifiable, and may act synergistically requiring integrated care.

RESUMO: Introdução: Os transtornos mentais e decorrentes do uso de substâncias psicoativas (TM) são altamente prevalentes, gerando elevado custo social e econômico. Objetivo: Descrever a carga dos TM no Brasil e Unidades Federativas (UFs), em 1990 e 2015. Métodos: Estudo descritivo da carga de doença dos TM, por meio de estimativas padronizadas por idade do Global Burden of Disease Study 2015: anos de vida perdidos por morte prematura (YLL); anos vividos com incapacidade (YLD); e anos de vida perdidos por morte ou incapacidade (DALY=YLL+YLD). Resultados: No Brasil, apesar da baixa taxa de mortalidade, observa-se alta carga para os TM desde 1990, com elevados YLD. Em 2015, esses transtornos foram responsáveis por 9,5% do total de DALY, ocupando a 3ª e a 1ª posições na classificação de DALY e YLD, respectivamente, com destaque para os transtornos depressivos e de ansiedade. Os transtornos decorrentes do uso de drogas apresentaram a maior elevação das taxas de DALY entre 1990 e 2015 (37,1%). A maior proporção de DALY ocorreu na idade adulta e no sexo feminino. Não houve diferenças substanciais na carga dos TM entre as UFs. Conclusão: Apesar da baixa mortalidade, os TM são altamente incapacitantes, indicando necessidade de ações preventivas e protetivas, principalmente na atenção primária em saúde. A homogeneidade das estimativas em todas as UFs, obtidas a partir de estudos realizados majoritariamente nas regiões Sul e Sudeste, provavelmente não reflete a realidade do Brasil, e indica necessidade de estudos em todas as regiões do país.

ABSTRACT: Introduction: Mental and substance use disorders (MD) are highly prevalent and have a high social and economic cost. Objective: To describe the burden of disease attributable to mental and substance use disorders in Brazil and Federated Units in 1990 and 2015. Methods: Descriptive study of the burden of mental and substance use disorders, using age-standardized estimates from the Global Burden of Disease Study 2015: years of life lost due to premature mortality (YLL); years lived with disability (YLD); and disability-adjusted life year (DALY=YLL+YLD). Results: In Brazil, despite low mortality rates, there has been a high burden for mental and substance use disorders since 1990, with high YLD. In 2015, these disorders accounted for 9.5% of all DALY, ranking in the third and first position in DALY and YLD, respectively, with an emphasis on depressive and anxiety disorders. Drug use disorders had their highest increase in DALY rates between 1990 and 2015 (37.1%). The highest proportion of DALY occurred in adulthood and in females. There were no substantial differences in burden of mental and substance use disorders among Federated Units. Conclusion: Despite a low mortality rate, mental and substance use disorders are highly disabling, which indicates the need for preventive and protective actions, especially in primary health care. The generalization of estimates in all the Federated Units obtained from studies conducted mostly in the south and southeast regions probably does not reflect the reality of Brazil, indicating the need for studies in all regions of the country.

RESUMO: Introdução: O uso de álcool é um dos principais fatores de risco preveníveis para mortalidade ou incapacidade prematuras. Objetivo: Descrever as estimativas de mortalidade e anos de vida perdidos por morte prematura (YLL) por cirrose, câncer hepático e transtornos devidos ao uso de álcool no Brasil e suas unidades da federação (UFs), em 1990 e 2015. Métodos: Estudo descritivo com dados do estudo de Carga Global de Doenças (2015) e do Sistema de Informações sobre Mortalidade (SIM). Modelos estatísticos foram empregados para obter estimativas corrigidas de mortalidade pelas causas selecionadas. As taxas de mortalidade foram padronizadas por idade (TMPI). Resultados: Em 1990, foram estimados 16.226 óbitos para as 3 condições (17,0/100 mil habitantes), enquanto em 2015 foram 28.337 (15,7/100 mil habitantes). Houve redução da mortalidade (por 100 mil habitantes) por cirrose (de 11,4 para 9,5) e estabilidade por câncer hepático (1,5 e 1,9) e transtornos devidos ao uso de álcool (4,1 e 4,3). As TMPI foram 5,1 vezes maiores entre os homens, e as 5 UFs com maiores TMPI e YLL foram da Região Nordeste: Sergipe, Ceará, Pernambuco, Paraíba e Alagoas. As taxas de mortalidade e de YLL pelas três condições estudadas ascenderam no ranking das causas de óbito, em ambos os sexos, exceto a cirrose no feminino. Conclusão: As três condições estudadas são responsáveis por importante carga de mortalidade prematura no Brasil, principalmente entre homens e residentes na região nordeste. Esses resultados reforçam a necessidade de políticas públicas para o enfrentamento ao consumo nocivo do álcool no Brasil.

ABSTRACT: Introduction: Alcohol use is one of the main preventable risk factors affecting mortality and premature disability. Objective: To describe the estimates of mortality and years of life lost as a result of premature death (YLL) due to cirrhosis, liver cancer, and disorders attributed to alcohol use in Brazil and its federated units in 1990 and 2015. Methods: Descriptive study using data from the Global Burden of Disease Study (2015) and the Mortality Information System (SIM). Statistical models were used to obtain corrected mortality estimates for selected causes. Rates were standardized by age. Results: In 1990, 16,226 deaths were estimated for the three conditions (17.0/100 thousand inhabitants), while in 2015 there were 28,337 deaths (15.7/100 thousand inhabitants). There was a reduction in mortality (per 100 thousand) due to cirrhosis (from 11.4 to 9.5), stability in mortality rates related to liver cancer (1.5 and 1.9), and stability in mortality rates caused by alcohol use disorders (4.1 and 4.3). Mortality rates were 5.1 times higher among men, and the five states with the highest mortality rates and YLL were from the Northeast Region: Sergipe, Ceará, Pernambuco, Paraíba, and Alagoas. Mortality and YLL rates for the three conditions studied increased in the ranking of causes of death in both sexes, with the exception of cirrhosis in the female population. Conclusion: The three conditions studied are responsible for a significant burden of premature mortality in Brazil, especially among men and residents of the northeast region. These results reinforce the urgent need for public policies that address harmful alcohol consumption in Brazil.