title: Mental disorders in megacities: findings from the São Paulo megacity mental health survey, Brazil.
abstract: BACKGROUND
  World population growth is projected to be concentrated in megacities, with increases in social inequality and urbanization-associated stress. São Paulo Metropolitan Area (SPMA) provides a forewarning of the burden of mental disorders in urban settings in developing world. The aim of this study is to estimate prevalence, severity, and treatment of recently active DSM-IV mental disorders. We examined socio-demographic correlates, aspects of urban living such as internal migration, exposure to violence, and neighborhood-level social deprivation with 12-month mental disorders.
  
  
  RESULTS
  A representative cross-sectional household sample of 5,037 adults was interviewed face-to-face using the WHO Composite International Diagnostic Interview (CIDI), to generate diagnoses of DSM-IV mental disorders within 12 months of interview, disorder severity, and treatment. Administrative data on neighborhood social deprivation were gathered. Multiple logistic regression was used to evaluate individual and contextual correlates of disorders, severity, and treatment. Around thirty percent of respondents reported a 12-month disorder, with an even distribution across severity levels. Anxiety disorders were the most common disorders (affecting 19.9%), followed by mood (11%), impulse-control (4.3%), and substance use (3.6%) disorders. Exposure to crime was associated with all four types of disorder. Migrants had low prevalence of all four types compared to stable residents. High urbanicity was associated with impulse-control disorders and high social deprivation with substance use disorders. Vulnerable subgroups were observed: women and migrant men living in most deprived areas. Only one-third of serious cases had received treatment in the previous year.
  
  
  CONCLUSIONS
  Adults living in São Paulo megacity had prevalence of mental disorders at greater levels than similar surveys conducted in other areas of the world. Integration of mental health promotion and care into the rapidly expanding Brazilian primary health system should be strengthened. This strategy might become a model for poorly resourced and highly populated developing countries.
authors.affiliation: Section of Psychiatric Epidemiology-LIM 23, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil. lhsgandr@usp.br
authors.forename: Laura Helena
authors.initials: LH
authors.lastname: Andrade
authors.forename: Yuan-Pang
authors.initials: YP
authors.lastname: Wang
authors.forename: Solange
authors.initials: S
authors.lastname: Andreoni
authors.forename: Camila Magalhães
authors.initials: CM
authors.lastname: Silveira
authors.forename: Clovis
authors.initials: C
authors.lastname: Alexandrino-Silva
authors.forename: Erica Rosanna
authors.initials: ER
authors.lastname: Siu
authors.forename: Raphael
authors.initials: R
authors.lastname: Nishimura
authors.forename: James C
authors.initials: JC
authors.lastname: Anthony
authors.forename: Wagner Farid
authors.initials: WF
authors.lastname: Gattaz
authors.forename: Ronald C
authors.initials: RC
authors.lastname: Kessler
authors.forename: Maria Carmen
authors.initials: MC
authors.lastname: Viana
mesh_terms: D001938:Brazil / Q000453:epidemiology; D002947:Cities; D003906:Developing Countries; D006306:Health Surveys; D006801:Humans; D001523:Mental Disorders / Q000453:epidemiology*; D008603:Mental Health / Q000706:statistics & numerical data; D015995:Prevalence