title: The impact of epidemic violence on the prevalence of psychiatric disorders in Sao Paulo and Rio de Janeiro, Brazil.
abstract: BACKGROUND
  Violence and other traumatic events, as well as psychiatric disorders are frequent in developing countries, but there are few population studies to show the actual impact of traumatic events in the psychiatric morbidity in low and middle-income countries (LMIC).
  
  
  OBJECTIVE
  To study the relationship between traumatic events and prevalence of mental disorders in São Paulo and Rio de Janeiro, Brazil.
  
  
  METHODS
  Cross-sectional survey carried out in 2007-2008 with a probabilistic representative sample of 15- to 75-year-old residents in Sao Paulo and Rio de Janeiro, Brazil, using the Composite International Diagnostic Interview.
  
  
  RESULTS
  The sample comprised 3744 interviews. Nearly 90% of participants faced lifetime traumatic events. Lifetime prevalence of any disorders was 44% in Sao Paulo and 42.1% in Rio de Janeiro. One-year estimates were 32.5% and 31.2%. One-year prevalence of traumatic events was higher in Rio de Janeiro than Sao Paulo (35.1 vs. 21.7; p<0.001). Participants from Rio de Janeiro were less likely to have alcohol dependence (OR = 0.55; p = 0.027), depression (OR = 0.6; p = 0.006) generalized anxiety (OR = 0.59; p = 0.021) and post-traumatic stress disorder (OR = 0.62; p = 0.027). Traumatic events correlated with all diagnoses--e.g. assaultive violence with alcohol dependence (OR = 5.7; p<0.001) and with depression (OR = 1.7; p = 0.001).
  
  
  CONCLUSIONS
  Our findings show that psychiatric disorders and traumatic events, especially violence, are extremely common in Sao Paulo and Rio de Janeiro, supporting the idea that neuropsychiatric disorders and external causes have become a major public health priority, as they are amongst the leading causes of burden of disease in low and middle-income countries. The comparison between the two cities regarding patterns of violence and psychiatric morbidity suggests that environmental factors may buffer the negative impacts of traumatic events. Identifying such factors might guide the implementation of interventions to improve mental health and quality of life in LMIC urban centers.
authors.affiliation: Departmento de Psiquiatria, Universidade Federal de São Paulo, Sao Paulo, Brazil. wagner.ribeiro@me.com
authors.forename: Wagner Silva
authors.initials: WS
authors.lastname: Ribeiro
authors.forename: Jair de Jesus
authors.initials: Jde J
authors.lastname: Mari
authors.forename: Maria Inês
authors.initials: MI
authors.lastname: Quintana
authors.forename: Michael E
authors.initials: ME
authors.lastname: Dewey
authors.forename: Sara
authors.initials: S
authors.lastname: Evans-Lacko
authors.forename: Liliane Maria Pereira
authors.initials: LM
authors.lastname: Vilete
authors.forename: Ivan
authors.initials: I
authors.lastname: Figueira
authors.forename: Rodrigo Affonseca
authors.initials: RA
authors.lastname: Bressan
authors.forename: Marcelo Feijó
authors.initials: MF
authors.lastname: de Mello
authors.forename: Martin
authors.initials: M
authors.lastname: Prince
authors.forename: Cleusa P
authors.initials: CP
authors.lastname: Ferri
authors.forename: Evandro Silva Freire
authors.initials: ES
authors.lastname: Coutinho
authors.forename: Sérgio Baxter
authors.initials: SB
authors.lastname: Andreoli
mesh_terms: D001938:Brazil / Q000453:epidemiology; D003430:Cross-Sectional Studies; D006801:Humans; D016015:Logistic Models; D001523:Mental Disorders / Q000453:epidemiology* / Q000209:etiology*; D016017:Odds Ratio; D015995:Prevalence; D014505:Urban Population / Q000706:statistics & numerical data*; D014754:Violence / Q000523:psychology*