Objective: Few pandemic studies have explored positive aspects of mental health employing an intersectional perspective. Our intersectional investigation aimed to identify mental illness and well-being differences between groups identified as psychologically vulnerable during the pandemic by the World Health Organization (immigrants, minorities, and people with psychiatric diagnoses) and people without pre-existing risk factors while controlling for sociodemographic variables. Methods: This cross-sectional survey included 1,134 participants (76.1% women) aged 18 to 76 years. We used the Depression, Anxiety, and Stress Scales to assess mental disorders and the Satisfaction with Life Scale and the Positive and Negative Affect Schedules to assess well-being. Results: Through a variable-centered approach, multivariate analysis revealed significant mental health differences between the groups: depression (F2.1131 = 72.7, p < 0.001), anxiety (F2.1131 = 78.0, p < 0.001), stress (F2.1131 = 85.9, p < 0.001), and subjective well-being (F2.1131 = 53.6, p < 0.001). The groups also differed when a person-centered approach was used to analyze the variables jointly through latent profile analysis. We identified six mental profiles consisting of different levels of depression, anxiety, stress, and well-being. The risk and intersectional groups were more likely to be characterized by the generalized suffering (ORrisk = 0.85, ORintersec = 0.93) and profound anguish (ORrisk&intersec = 0.97) profiles. After controlling for demographic variables, mental health disparities were partially attributed to participant risk conditions. Conclusions: Based on our results, we emphasize the urgent need for public health policies that consider the specificities and vulnerabilities of minority and risk groups.

This is the first of two documents prepared by experts for the Brazilian S20 mental health report. These reports outline strategies aimed at addressing the exacerbated mental health challenges arising from a post-pandemic world. Ongoing psychiatric epidemiology research has yielded evidence linking mental health with intricate social determinants, including gender, race/ethnicity, racism, socioeconomic status, social deprivation, and employment. More recently, the focus has expanded to also encompass violence and social oppression. By prioritizing prevention and early intervention, harnessing technology, and fostering community support, we can mitigate the long-term impact of emerging mental disorders throughout the life course. By utilizing evidence-based practices and forging partnerships between the health and education sectors, S20 countries can promote the health and safety of their student population, paving the way for a more promising future for the next generations. The first document focuses on addressing the mental health concerns of vulnerable populations, catering to the needs of children, youth, and aging populations, assessing the current state of alcohol and drug addictions, scaling up psychosocial interventions in primary care, exploring the potential integration of health and educational systems, and emphasizing the imperative adoption of human rights in mental health policies.

An integral part of Brazil’s public health system, psychiatric emergency services have been instrumental in improving qualified support for crisis situations involving mental disorders in an equitable, universally accessible, and humanized way. The purpose of this article is to present a systematic review and consensus on the infrastructure and the ideal team for psychiatric emergencies services in Brazil. The authors searched electronic databases including MEDLINE (PubMed), SciELO, and Cochrane, in addition to documents from the World Health Organization, the Brazilian Ministry of Health, and other authorities. Of the 6839 manuscripts found, 46 were included. The content analysis summarized consensus statements through the Delphi method, and, after a series of interactive versions, a final report was produced. Models for changing psychiatric emergency services are assessed. It was determined that the emergency care network must be supervised by qualified management, and all health equipment and units must be effectively integrated. Psychiatric emergency services need adequate infrastructure, qualified staff (including a psychiatrist), sufficient consultation and observation space, tools and resources for differential diagnosis, training for all staff members, and communication with the health care network to facilitate referrals following patient discharge. Standardized models should be available to public health managers to guide the development of new services and adjust existing ones, always seeking improvement. The authors propose a model of psychiatric emergency services.

Objective: To investigate the efficacy of repetitive transcranial magnetic stimulation (rTMS) for attention deficit/hyperactivity disorder (ADHD). Methods: Randomized sham-controlled trials were identified in major databases from January 1990 to January 2023. The primary outcome was overall improvement in ADHD symptoms. Subgroup analysis focused on the efficacy of rTMS in different brain regions. Secondary outcomes were the association of rTMS with improvement in different ADHD symptoms. Outcomes were expressed as effect size based on standardized mean difference (SMD)(continuous data), and ORs with 95%CI (categorical data). Results: A meta-analysis of six randomized sham-controlled trials involving 169 participants demonstrated no difference in overall ADHD symptoms between those treated with rTMS and sham controls (SMD = -0.24, p = 0.17). Subgroup analysis revealed that rTMS was more efficacious than sham treatment when targeting the right prefrontal cortex (SMD = -0.49, p = 0.03) but not the left prefrontal cortex (SMD = 0.01, p = 0.67). rTMS treatment was correlated with greater improvement in inattention (SMD = -0.76, p = 0.0002), but not hyperactivity (p = 0.86), impulsivity (p = 0.41), or depression symptoms (p = 0.95). The apparently higher risk of dropout in the rTMS group than the sham control group was not statistically significant (OR = 1.65, p = 0.26). Conclusion: This review found that rTMS only had therapeutic efficacy for ADHD symptoms (particularly inattention) when targeting the right prefrontal cortex. Further large-scale randomized sham-controlled trials are required to verify our findings. Registration number: PROSPERO CRD42023393713.

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.

Objective: To investigate Brazilian psychiatrists’ knowledge of and perceived confidence in diagnosis and evidence-based treatment recommendations for eating disorders. Methods: In this cross-sectional study, 259 psychiatrists filled out an online form including sociodemographic data and questions about the diagnosis and treatment of eating disorders based on standard guidelines. The sample’s knowledge level and perceived confidence regarding eating disorders were characterized using descriptive statistics. Results: The sample, which was predominantly women (65.64%), had a mean age of 42.86 years, was from southeastern Brazil (56.37%), worked predominantly in private practice (59.85%), and had less than 10 years of experience in psychiatry (51.74%). We found that 33.21% of the participants correctly identified the diagnostic criteria for anorexia nervosa, 29.73% for bulimia nervosa, and 38.22% for binge eating disorders. Correct answers for therapeutic options were similar for bulimia nervosa and binge eating disorder (20.8%) but were considerably lower for anorexia nervosa (2.7%). The participants’ training about eating disorders occurred during medical school (15.1%), medical residency/graduate study (59.8%), or as continuing education (58.7%). Only 8.89% felt satisfied with their training about eating disorders, 50.97% felt confident diagnosing eating disorders, and 37.07% felt confident about treating patients with eating disorders. Conclusion: These results show an important knowledge gap about eating disorders among Brazilian psychiatrists, which affects their confidence and competence in treating patients with eating disorders.

Objective: To test the efficacy of a dissonance-based (DB) intervention in targeting risk factors for eating disorders (EDs) and predisposing factors for muscle dysmorphia (MD) symptoms in body-dissatisfied Brazilian men over 1 year of follow-up and evaluate whether reductions in body-ideal internalization would mediate the intervention’s impact on ED and MD symptoms. Methods: Participants were randomized to a two-session DB intervention (n=89) or assessment-only control (AOC) (n=91), and completed validated measures assessing body-ideal internalization, body dissatisfaction, ED, and MD symptoms at baseline, post-intervention, 1-month, 6-month, and 1-year follow-ups. Results: The DB condition showed significantly greater reductions in MD symptoms and body dissatisfaction compared with the AOC group over a 1-year follow-up, while significant differences were not observed for body-ideal internalization and ED symptoms. Changes in body-ideal internalization from baseline to 1-month follow-up completely mediated the relationship between condition and the changes observed in both ED and MD symptoms. Conclusion: These results provide further evidence of the efficacy of the tested intervention through 1-year follow-up in reducing body dissatisfaction and MD symptoms, but no such result was observed for body-ideal internalization and EDs. Our findings provide support for theoretical models of eating pathology and MD symptoms in Brazilian men. Clinical Trial Registration: Brazilian Registry of Clinical Trials (ReBEC): RBR-27dc264.