OBJECTIVE: To determine whether brief intervention and contact is effective in reducing subsequent suicide mortality among suicide attempters in low and middle-income countries. METHODS: Suicide attempters (n = 1867) identified by medical staff in the emergency units of eight collaborating hospitals in five culturally different sites (Campinas, Brazil; Chennai, India; Colombo, Sri Lanka; Karaj, Islamic Republic of Iran; and Yuncheng, China) participated, from January 2002 to October 2005, in a randomized controlled trial to receive either treatment as usual, or treatment as usual plus brief intervention and contact (BIC), which included patient education and follow-up. Overall, 91% completed the study. The primary study outcome measurement was death from suicide at 18-month follow-up. FINDINGS: Significantly fewer deaths from suicide occurred in the BIC than in the treatment-as-usual group (0.2% versus 2.2%, respectively; χ2 = 13.83, P < 0.001). CONCLUSION: This low-cost brief intervention may be an important part of suicide prevention programmes for underresourced low- and middle-income countries.

OBJETIVO: Determinar si una intervención de información breve y contactos es una medida eficaz para reducir la mortalidad posterior por suicidio entre quienes han intentado suicidarse en los países de ingresos bajos y medios. MÉTODOS: Un total de 1867 personas que habían intentado suicidarse seleccionadas por personal médico en los servicios de urgencia de ocho hospitales colaboradores en cinco lugares con distinto contexto cultural (Campinas, Brasil; Chennai, India; Colombo, Sri Lanka; Karaj, República Islámica del Irán; y Yuncheng, China) participaron entre enero de 2002 y octubre de 2005 en un ensayo controlado aleatorizado para someterse bien al tratamiento habitual, o bien al tratamiento habitual más una intervención consistente en una sesión breve de información y educación del paciente y una serie de contactos de seguimiento (I+C). Globalmente, finalizaron el estudio el 91% de los pacientes. La variable principal de medición del resultado del estudio fue la muerte por suicidio en los 18 meses de seguimiento. RESULTADOS: En el grupo sometido a I+C se observó una tasa de defunciones por suicidio significativamente menor que en el grupo tratado de la forma habitual (0,2% frente al 2,2%, respectivamente; χ2 = 13,83, p < 0,001). CONCLUSIÓN: Esta intervención breve de bajo costo podría ser un componente importante de los programas de prevención del suicidio en los países de ingresos bajos y medios que carecen de recursos suficientes.

OBJECTIF: Déterminer si une intervention et un contact brefs peuvent être efficaces pour réduire la mortalité ultérieur par suicide chez les personnes ayant tenté de se suicider dans les pays à revenu faible et moyen. MÉTHODES: Des personnes ayant tenté de se suicider (n = 1867), identifiées par le personnel médical des services d'urgence de huit hôpitaux collaborateurs dans cinq sites culturellement différents (Campinas au Brésil, Chennai en Inde, Colombo au Sri Lanka ; Karaj en République islamique d'Iran, et Yuncheng en Chine), ont participé, de janvier 2002 à octobre 2005, à un essai contrôlé randomisé et dans ce cadre, ont bénéficié d'un traitement comme à l'habitude ou d'un tel traitement complété par une intervention et un contact brefs (BIC), comprenant une éducation et un suivi du patient. Globalement, 91 % de ces personnes sont allées jusqu'au bout de l'essai. La principale mesure de résultat de l'étude était la mortalité par suicide à 18 mois de suivi. RÉSULTATS: Le nombre de décès par suicide était significativement plus faible parmi le groupe ayant bénéficié de la procédure BIC que dans le groupe ayant reçu le traitement habituel (0,2 % contre 2,2 % respectivement, χ2 = 13,83, p< 0,001). CONCLUSION: Cette intervention brève et peu onéreuse peut constituer une composante importante des programmes de prévention du suicide dans les pays à revenu faible et moyen manquant de ressources.

A fim de determinar a prevalência de transtornos mentais em uma amostra de pacientes de um hospital geral e sua relação com a denominação religiosa e religiosidade, foram investigados 253 pacientes internados no Hospital das Clínicas da Universidade Estadual de Campinas por intermédio de um questionário sócio-demográfico e um instrumento para diagnóstico psiquiátrico (MINI-Plus). A maioria dos pacientes era católica (63,2%; n = 177); seguidos dos evangélicos pentecostais (20,4%; n = 57); dos "sem-religião" (7,5%; n = 21); espíritas (4,3%; n = 12) e protestantes históricos (2,3%; n = 8). Consideraram-se muito religiosos 43,2% (n = 116), religiosos 46,9% (n = 129), pouco religiosos 9,8% (n = 27), não religiosos 1,1% (n = 3). A filiação religiosa evangélica e maior freqüência a cultos relacionaram-se à menor freqüência de problemas com álcool. É possível que a filiação religiosa evangélica exerça uma ação inibidora na ocorrência de transtornos relacionados ao álcool. Indivíduos muito religiosos ou pouco/nada religiosos apresentaram maior prevalência de transtorno bipolar. A dimensão intensidade da religiosidade revelou-se modestamente associada à prevalência geral dos transtornos, especialmente ao transtorno bipolar. É razoável que situações extremas (de muito ou reduzido envolvimento) relacionem-se a tal achado, relacionando tanto a busca exacerbada ou o afastamento da religiosidade com estados mentais alterados.

In order to evaluate the prevalence of psychiatric disorders in a Brazilian general hospital and their association with religious denomination and religiosity, 253 inpatients were interviewed. A socio-demographic questionnaire and an instrument for diagnosis of mental disorders (MINI-Plus) were applied. Distribution of religious denominations was: Catholic 63.2% (n = 177), Evangelical Protestant 20.4% (n = 57), Spiritist 4.3% (n = 12), traditional Protestant 2.3% (n = 8), and "no religion" 7.5% (n = 21). Degree of religiosity was: very religious 43.2% (n = 116), religious 46.9% (n = 129), hardly religious 9.8% (n = 27), and not at all religious 1.1% (n = 3). Evangelical (Pentecostal) religious affiliation and frequent attendance at worship services were associated with fewer alcohol problems. Membership in an Evangelical (Pentecostal) church may thus have an inhibitory effect on alcohol dependence or abuse. Intensity of religiosity was moderately associated with overall prevalence of disorders, especially bipolar disorder. It is reasonable to conclude that extreme situations (very intense versus very limited religious participation) are related to this finding, associating both an exacerbated pursuit of religion and alienation from it with altered mental states.

A fim de determinar a prevalência de transtornos mentais em uma amostra de pacientes de um hospital geral e sua relação com a denominação religiosa e religiosidade, foram investigados 253 pacientes internados no Hospital das Clínicas da Universidade Estadual de Campinas por intermédio de um questionário sócio-demográfico e um instrumento para diagnóstico psiquiátrico (MINI-Plus). A maioria dos pacientes era católica (63,2%; n = 177); seguidos dos evangélicos pentecostais (20,4%; n = 57); dos "sem-religião" (7,5%; n = 21); espíritas (4,3%; n = 12) e protestantes históricos (2,3%; n = 8). Consideraram-se muito religiosos 43,2% (n = 116), religiosos 46,9% (n = 129), pouco religiosos 9,8% (n = 27), não religiosos 1,1% (n = 3). A filiação religiosa evangélica e maior freqüência a cultos relacionaram-se à menor freqüência de problemas com álcool. É possível que a filiação religiosa evangélica exerça uma ação inibidora na ocorrência de transtornos relacionados ao álcool. Indivíduos muito religiosos ou pouco/nada religiosos apresentaram maior prevalência de transtorno bipolar. A dimensão intensidade da religiosidade revelou-se modestamente associada à prevalência geral dos transtornos, especialmente ao transtorno bipolar. É razoável que situações extremas (de muito ou reduzido envolvimento) relacionem-se a tal achado, relacionando tanto a busca exacerbada ou o afastamento da religiosidade com estados mentais alterados.

In order to evaluate the prevalence of psychiatric disorders in a Brazilian general hospital and their association with religious denomination and religiosity, 253 inpatients were interviewed. A socio-demographic questionnaire and an instrument for diagnosis of mental disorders (MINI-Plus) were applied. Distribution of religious denominations was: Catholic 63.2% (n = 177), Evangelical Protestant 20.4% (n = 57), Spiritist 4.3% (n = 12), traditional Protestant 2.3% (n = 8), and "no religion" 7.5% (n = 21). Degree of religiosity was: very religious 43.2% (n = 116), religious 46.9% (n = 129), hardly religious 9.8% (n = 27), and not at all religious 1.1% (n = 3). Evangelical (Pentecostal) religious affiliation and frequent attendance at worship services were associated with fewer alcohol problems. Membership in an Evangelical (Pentecostal) church may thus have an inhibitory effect on alcohol dependence or abuse. Intensity of religiosity was moderately associated with overall prevalence of disorders, especially bipolar disorder. It is reasonable to conclude that extreme situations (very intense versus very limited religious participation) are related to this finding, associating both an exacerbated pursuit of religion and alienation from it with altered mental states.

OBJECTIVE: To evaluate the concurrent validity, internal consistency and responsiveness of King's Health Questionnaire (KHQ) in patients who underwent sling procedures for the treatment of stress urinary incontinence. MATERIALS AND METHODS: We performed a prospective open label multicenter study in 4 tertiary referral centers. Sixty-eight female patients were enrolled with urodynamically diagnosed urinary stress incontinence. Patients were treated using surgical procedures, mostly (73%) with the synthetic sling procedure, which has been considered one of the gold standard methods for the treatment of urinary incontinence. The patients were assessed before and after one month of postoperative follow up, using the KHQ in its validated Portuguese version. Patients also underwent preoperative urodynamic test, Stamey incontinence grading, pad usage and the assessment of number of pads used per day. After surgery, patients underwent stress test, Stamey incontinence grading pad usage and the assessment of number of pads used per day. RESULTS: The concurrent validity showed good correlations in some domains of KHQ to clinical parameters. The internal consistency was higher after treatment compared to preoperative values. Objective parameters, such as pad usage and the assessment of number of pads used per day, had significant correlation with changes in post-treatment scores on KHQ. The responsiveness expressed in terms of standardized effect size (SES) and standardized response mean (SRM) was large. CONCLUSION: The results showed moderate concurrent validity, strong internal consistency and high responsiveness for KHQ, indicating that it is suitable for measuring outcomes in clinical trials among female patients with stress urinary incontinence.

OBJETIVO: A internação psiquiátrica, embora onerosa, continua sendo um recurso terapêutico indispensável para pacientes graves. A internação em unidades psiquiátricas de hospital geral (UPHG) tem sido recomendada como a melhor alternativa aos macro-hospitais psiquiátricos. Nesse sentido, realizou-se estudo com o objetivo de verificar variáveis socioeconômicas e clínicas associadas com o êxito ou o fracasso da internação. MÉTODOS: Foram revistos dados sociodemográficos e clínicos de 1.463 pacientes internados em uma UPHG de hospital geral no período 1986-1997, utilizando-se análise de regressão logística politômica univariada e multivariada. RESULTADOS: Por meio da análise multivariada, foram identificados três fatores associados a um pior desfecho da internação (condição de alta ruim e maior tempo de permanência): idade >60 anos, não exercício prévio de função social e diagnóstico de transtorno psicorgânico. CONCLUSÃO: Embora mais de 80% dos pacientes tratados nessa UPHG tenham apresentado significativa melhora dos sintomas, um subgrupo se beneficiou menos da internação, parecendo requerer intervenções de reabilitação psicossocial ao invés da hospitalização.

OBJECTIVES: Psychiatric hospitalization though burdensome remains a very important therapeutic option for severely-ill psychiatric patients. Hospitalization in general hospital psychiatry units (GHPU) are often regarded as the best option. A study was carried out with the purpose of assessing socioeconomic and medical variables associated with success and failure of hospitalization. METHODS: A review was performed on sociodemographics and medical data of 1,463 patients admitted to a general hospital's GHPU in the period between 1986 and 1997. Statistical analysis was conducted using univariate and multivariate polythomic logistic regression. RESULTS: In the multivariate analysis three factors were identified as associated to poor hospitalization outcomes (poor condition at discharge and longer hospital stay): age >60 years, poor social functioning, and diagnosis of organic mental disorder. CONCLUSIONS: Although 80% of the patients experienced a considerable symptomatic improvement, a small group benefited less from hospitalization. It is suggestive that these patients would benefit more from psychosocial interventions.

OBJETIVO: A internação psiquiátrica, embora onerosa, continua sendo um recurso terapêutico indispensável para pacientes graves. A internação em unidades psiquiátricas de hospital geral (UPHG) tem sido recomendada como a melhor alternativa aos macro-hospitais psiquiátricos. Nesse sentido, realizou-se estudo com o objetivo de verificar variáveis socioeconômicas e clínicas associadas com o êxito ou o fracasso da internação. MÉTODOS: Foram revistos dados sociodemográficos e clínicos de 1.463 pacientes internados em uma UPHG de hospital geral no período 1986-1997, utilizando-se análise de regressão logística politômica univariada e multivariada. RESULTADOS: Por meio da análise multivariada, foram identificados três fatores associados a um pior desfecho da internação (condição de alta ruim e maior tempo de permanência): idade >60 anos, não exercício prévio de função social e diagnóstico de transtorno psicorgânico. CONCLUSÃO: Embora mais de 80% dos pacientes tratados nessa UPHG tenham apresentado significativa melhora dos sintomas, um subgrupo se beneficiou menos da internação, parecendo requerer intervenções de reabilitação psicossocial ao invés da hospitalização.

OBJECTIVES: Psychiatric hospitalization though burdensome remains a very important therapeutic option for severely-ill psychiatric patients. Hospitalization in general hospital psychiatry units (GHPU) are often regarded as the best option. A study was carried out with the purpose of assessing socioeconomic and medical variables associated with success and failure of hospitalization. METHODS: A review was performed on sociodemographics and medical data of 1,463 patients admitted to a general hospital's GHPU in the period between 1986 and 1997. Statistical analysis was conducted using univariate and multivariate polythomic logistic regression. RESULTS: In the multivariate analysis three factors were identified as associated to poor hospitalization outcomes (poor condition at discharge and longer hospital stay): age >60 years, poor social functioning, and diagnosis of organic mental disorder. CONCLUSIONS: Although 80% of the patients experienced a considerable symptomatic improvement, a small group benefited less from hospitalization. It is suggestive that these patients would benefit more from psychosocial interventions.

Para estimar a prevalência de transtornos do humor, foram utilizadas a entrevista estruturada, "Clinical Interview Schedule" (CIS-R), e a escala "Hospital Anxiety and Depression" (HAD) em 78 pacientes internados em uma enfermaria geral de adultos (43 homens e 35 mulheres, média de idade = 43,2 anos). Foi encontrada prevalência instantânea de 39% de transtornos do humor. Dezesseis (20,5%) pacientes preencheram critérios para ansiedade, a maioria dos casos sendo de gravidade leve. Vinte e seis (33%) casos de depressão foram detectados, 7 dos quais de gravidade moderada. Observou-se uma combinação de sintomas de preocupação, depressão, ansiedade e insônia. A HAD mostrou-se de fácil compreensão pelos pacientes. As subescalas de ansiedade e de depressão tiveram consistência interna de 0,68 e 0,77, respectivamente. A correlação dos itens com as respectivas subescalas sugere que essas possuem validades convergentes, não discriminantes. Com ponto de corte 8/9, a sensibilidade e a especificidade foram 93,7% e 72,6%, para ansiedade, e 84,6% e 90,3%, para depressão. Na prática clínica, a utilização da HAD poderia auxiliar na detecção de casos de transtornos do humor que necessitam de tratamento.

The revised Clinical Interview Schedule (CIS-R) and the Hospital Anxiety and Depression (HAD) Scale were used to estimate the prevalence of mood disorders among 78 consecutive admissions to a general medical ward in a university general hospital in Brazil (43 males and 35 females; mean age = 43.2yr). Interviewers also completed a 5-point symptom severity scales for anxiety and depression. The definition of cases of anxiety [and depression] was based on two criteria: a. score > 2 on the CIS-R section of anxiety [> 4 on the CIS-R sections of depression and depressive ideas]; and b. score > 2 on the clinical severity scale for anxiety [score > 2 on the clinical severity scale for depression]. A 39% prevalence rate of affective disorders was found. Sixteen (20.5%) patients met criteria for anxiety, most of the disorders being of mild severity. Twenty-sic patients (33%) were depressed, 7 of them in a moderate degree. The HAD was easily understood by the patients. Anxiety and depression subscales had internal consistency of 0.68 and 0.77, respectively. At a cut-off point of 8/9 sensibility and specificity were 93.7% and 72.6% for anxiety, and 84.6% and 90.3% for depression. HAD items correlated positively with the respective subscales. To a lesser degree, they also correlated with the alternative subscale. Our findings confirm the high prevalence of mood disorders among medical in-patients. In clinical practice, the HAD may have a useful role in detecting those patients requiring further psychological care.

Para estimar a prevalência de transtornos do humor, foram utilizadas a entrevista estruturada, "Clinical Interview Schedule" (CIS-R), e a escala "Hospital Anxiety and Depression" (HAD) em 78 pacientes internados em uma enfermaria geral de adultos (43 homens e 35 mulheres, média de idade = 43,2 anos). Foi encontrada prevalência instantânea de 39% de transtornos do humor. Dezesseis (20,5%) pacientes preencheram critérios para ansiedade, a maioria dos casos sendo de gravidade leve. Vinte e seis (33%) casos de depressão foram detectados, 7 dos quais de gravidade moderada. Observou-se uma combinação de sintomas de preocupação, depressão, ansiedade e insônia. A HAD mostrou-se de fácil compreensão pelos pacientes. As subescalas de ansiedade e de depressão tiveram consistência interna de 0,68 e 0,77, respectivamente. A correlação dos itens com as respectivas subescalas sugere que essas possuem validades convergentes, não discriminantes. Com ponto de corte 8/9, a sensibilidade e a especificidade foram 93,7% e 72,6%, para ansiedade, e 84,6% e 90,3%, para depressão. Na prática clínica, a utilização da HAD poderia auxiliar na detecção de casos de transtornos do humor que necessitam de tratamento.

The revised Clinical Interview Schedule (CIS-R) and the Hospital Anxiety and Depression (HAD) Scale were used to estimate the prevalence of mood disorders among 78 consecutive admissions to a general medical ward in a university general hospital in Brazil (43 males and 35 females; mean age = 43.2yr). Interviewers also completed a 5-point symptom severity scales for anxiety and depression. The definition of cases of anxiety [and depression] was based on two criteria: a. score > 2 on the CIS-R section of anxiety [> 4 on the CIS-R sections of depression and depressive ideas]; and b. score > 2 on the clinical severity scale for anxiety [score > 2 on the clinical severity scale for depression]. A 39% prevalence rate of affective disorders was found. Sixteen (20.5%) patients met criteria for anxiety, most of the disorders being of mild severity. Twenty-sic patients (33%) were depressed, 7 of them in a moderate degree. The HAD was easily understood by the patients. Anxiety and depression subscales had internal consistency of 0.68 and 0.77, respectively. At a cut-off point of 8/9 sensibility and specificity were 93.7% and 72.6% for anxiety, and 84.6% and 90.3% for depression. HAD items correlated positively with the respective subscales. To a lesser degree, they also correlated with the alternative subscale. Our findings confirm the high prevalence of mood disorders among medical in-patients. In clinical practice, the HAD may have a useful role in detecting those patients requiring further psychological care.