Psychiatric morbidity and quality of life of primary
					care attenders in two cities in Brazil

Portugal, Flávia Batista; Campos, Mônica Rodrigues; Gonçalves, Daniel Almeida; Mari, Jair de Jesus; Gask, Linda; Bower, Peter; Dowrick, Christopher; Fortes, Sandra

doi:10.1590/0047-2085000000004

Flávia Batista Portugal

Oswaldo Cruz Foundation, Sergio Arouca National School of Public Health (Fiocruz-ENSP)

Mônica Rodrigues Campos

Fiocruz-ENSP, Social Sciences Department

Daniel Almeida Gonçalves

Universidade Federal de São Paulo (Unifesp)

Jair de Jesus Mari

Unifesp, Department of Psychiatry

Linda Gask

University of Manchester, Manchester Academic Health Science Centre, NIHR School for Primary Care Research

Peter Bower

University of Manchester, Manchester Academic Health Science Centre, NIHR School for Primary Care Research, Health Services Research

Christopher Dowrick

Community and Behavioral Sciences, School of Population, Primary Medical Care

Sandra Fortes

Rio de Janeiro State University (UERJ)

Correspondence address to: Flávia Batista Portugal Rua Manoel Barros da Costa, 61, ap. 501, Jardim Camburi 29090-730 – Vitória, ES, Brazil Email: flaviabportugal@gmail.com

INDIVIDUAL CONTRIBUTIONS

Flávia Batista Portugal – Contributed in study design, analysis of results, drafting of the article and approved its final version.

Mônica Rodrigues Campos – Contributed in study design, analysis of results and preparation of the article and approved its final version.

Daniel Almeida Gonçalves – Contributed in study design, in data collection, the preparation of the article and approved its final version.

Jair de Jesus Mari – Contributed in designing the study, revising it and approved its final version.

Linda Gask – Contributed in designing the study, revising it and approved its final version.

Peter Bower – Contributed in designing the study, revising it and approved its final version.

Christopher Dowrick – Contributed in designing the study, revising it and approved its final version.

Sandra Fortes – Contributed in study design, in data collection, analysis of results, drafting of the article and approved its final version.

CONFLICT OF INTERESTS

The authors declare no conflicts of interest.

RESEARCH BUDGET

Sandra Fortes – Projeto Avaliação de um modelo de capacitação em saúde mental na atenção básica: cuidados integrais na prática do matriciamento – 575194/2008-1 – Edital MCT/CNPq/CT-Saúde/MS/SCTIE-DCIT – no33/2008 Flávia Batista Portugal – Bolsista de doutorado do CNPq.


Rio de Janeiro

Characteristics	CMD3 = 20.9%			CMD5 = 31%			Anxiety = 35.4%			Depression = 25%

	N (%)	OR (IC95%)	p-value	N (%)	OR (IC95%)	p-value	N (%)	OR (IC95%)	p-value	N (%)	OR (IC95%)	p-value

Gender
Female	158 (83.2%)	0.7 (0.4-1.0)	0.054	245 (86.9%)	2.3 (1.6-3.4)	< 0.001	268 (83.2%)	1.6 (1.2-2.3)	0.005	197 (86.8%)	2.2 (1.4-3.3)	< 0.001
Male	32 (16.8%)	1.0	0.054	37 (13.1%)	1.0	< 0.001	54 (16.8%)	1.0	0.005	30 (13.2%)	1.0	< 0.001
Age group
≤ 40 y.o.	79 (41.6%)	0.9 (0.7-1.3)	0.78	125 (44.3%)	1.2 (0.9-1.7)	0.14	137 (42.5%)	1.25 (0.9-1.5)	0.40	92 (40.5%)	1.0 (0.7-1.3)	0.95
> 40 y.o.	111 (58.4%)	1.0	0.78	157 (55.7%)	1.0	0.14	185 (57.5%)	1.0	0.40	135 (59.5%)	1.0	0.95
Education level
≤ 4^th grade	72 (37.9%)	0.9 (0.6-1.2)	0.38	110 (39%)	1.3 (1.0-1.7)	0.11	121 (37.6%)	1.2 (0.9-1.6)	0.27	86 (37.9%)	1.2 (0.9-1.6)	0.33
> 4^th grade	118 (62.1%)	1.0	0.38	172 (61%)	1.0	0.11	201 (62.4%)	1.0	0.27	141 (62.1%)	1.0	0.33
Per capita family income
≤ 0.5 min. wage	4 (2.3%)	1.4 (0.5-4.1)	0.54	10 (3.9%)	1.5 (0.7-3.3)	0.35	13 (4.5%)	2.0 (0.9-4.5)	0.08	6 (3.0%)	1.0 (0.4-2.4)	0.91
> 0.5 min. wage	167 (97.7%)	1.0	0.54	247 (96.1%)	1.0	0.35	277 (95.5%)	1.0	0.08	197 (97.0%)	1.0	0.91
São Paulo

Characteristics	CMD3 = 19.7%			CMD5 = 33.6%			Anxiety = 39.5%			Depression = 25.3%

	N (%)	OR (IC95%)	p-value	N (%)	OR (IC95%)	p-value	N (%)	OR (IC95%)	p-value	N (%)	OR (IC95%)	p-value

Gender
Female	80 (72.7%)	1.1 (0.8-1.7)	0.07	161 (86.1%)	2.9 (1.8-4.7)	< 0.001	181 (82.3%)	2.1 (1.4-3.2)	< 0.001	119 (84.4%)	2.3 (1.4-3.7)	0.001
Male	30 (27.3%)	1.0	0.07	26 (13.9%)	1.0	< 0.001	39 (17.7%)	1.0	< 0.001	22 (15.6%)	1.0	0.001
Age group
≤ 40 y.o.	30 (27.3%)	1.3 (0.8-2.1)	0.22	54 (28.9%)	0.8 (0.5-1.2)	0.24	70 (31.8%)	1.0 (0.7-1.4)	0. 90	39 (27.7%)	0.8 (0.5-1.1)	0.19
> 40 y.o.	80 (72.7%)	1.0	0.22	133 (71.1%)	1.0	0.24	150 (68.2%)	1.0	0. 90	102 (72.3%)	1.0	0.19
Education level
≤ 4^th grade	34 (30.9%)	1.0 (0.6-1.5)	0.85	64 (34.2%)	1.3 (0.9-2.0)	0.14	74 (33.6%)	1.3 (0.9-1.9)	0.15	50 (35.5%)	1.4 (0.9-2.1)	0.11
> 4^th grade	34 (30.9%)	1.0	0.85	123 (65.8%)	1.0	0.14	146 (66.4)	1.0	0.15	91 (64.5%)	1.0	0.11
Per capita family income
≤ 0.5 min. wage	2 (2.0%)	0.9 (0.2-4.3)	0.87	3 (1.9%)	1.1 (0.3-4.4)	0.91	4 (2.1%)	1.3 (0.4-5.0)	0.68	4 (3.4%)	2.6 (0.7-9.8)	1.0
> 0.5 min. wage	98 (98.0%)	1.0	0.87	154 (98.1%)	1.0	0.91	184 (97.9%)	1.0	0.68	115 (96.6%)	1.0	1.0
Total

Characteristics	CMD3 = 20.5%			CMD5 = 32%			Anxiety = 37%			Depression = 25.1%

	N (%)	OR (IC95%)	p-value	N (%)	OR (IC95%)	p-value	N (%)	OR (IC95%)	p-value	N (%)	OR (IC95%)	p-value

Gender
Female	238 (79.3%)	0.8 (0.6-1.1)	0.19	406 (86.6%)	2.5 (1.9-3.4)	< 0.001	449 (82.8%)	1.8 (1.4-2.4)	< 0.001	316 (85.9%)	2.1 (1.6-3.1)	0.001
Male	62 (20.7%)	1.0	0.19	63 (13.4%)	1.0	< 0.001	93 (17.2%)	1.0	< 0.001	52 (14.1%)	1.0	0.001
Age group
≤ 40 y.o.	109 (36.3%)	1.1 (0.8-1.4)	0.64	179 (38.2%)	1.2 (1.0-1.4)	0.70	207 (38.2%)	1.1 (0.8-1.3)	0.65	131 (35.6%)	0.8 (0.7-1.1)	0.40
> 40 y.o.	191 (63.7%)	1.0	0.64	290 (61.8%)	1.0	0.70	335 (61.8%)	1.0	0.65	237 (64.4%)	1.0	0.40
Education level
≤ 4^th grade	106 (35.3%)	0.9 (0.7-1.2)	0.40	174 (37.1%)	1.3 (1.0-1.6)	0.034	196 (36.2%)	1.2 (1.0-1.5)	0.12	137 (37.2%)	1.2 (1.0-1.6)	0.09
> 4^th grade	194 (64.7%)	1.0	0.40	295 (62.9%)	1.0	0.034	346 (63.8%)	1.0	0.12	231 (62.8%)	1.0	0.09
Per capita family income
≤ 0.5 min. wage	6 (2.2%)	1.2 (0.5-2.9)	0.66	13 (3.1%)	1.3 (0.7-2.7)	0.39	17 (3.6%)	1.8 (0.9-3.5)	0.09	10 (3.1%)	1.3 (0.6-2.7)	0.50
> 0.5 min. wage	265 (97.8%)	1.0		401 (96.9%)	1.0	0.39	461 (96.4%)	1.0	0.09	312 (96.9%)	1.0	0.50

Socioeconomic characteristics	Quality of life

	Physical	Psychological	Social relations	Environment
Rio de Janeiro

Gender
Female	64.7*	63.2*	69.3	48.1*
Male	68.2*	69.6*	71.4	52.0*
Age group
≤ 40 y.o.	67.5*	64.0	70.6	47.8*
> 40 y.o.	64.0*	65.0	69.1	49.7*
Education level
≤ 4^th grade	63.0*	62.3*	69.4	48.3
> 4^th grade	66.8*	65.9*	69.9	49.3
Per capita family income
≤ 0.5 min. wage	65.7	62.5	63.1	47.5
> 0.5 min. wage	65.3	64.5	70.1	49.0

São Paulo

Gender
Female	62.1*	62.4*	65.6	48.4*
Male	67.5*	67.6*	68.9	52.4*
Age group
≤ 40 y.o.	69.3*	66.8*	69.4*	51.0*
> 40 y.o.	60.8*	62.3*	65.1*	48.7*
Education level
≤ 4^th grade	58.9*	59.9*	66.3	47.8
> 4^th grade	65.6*	65.4*	66.6	50.1
Per capita family income
≤ 0.5 min. wage	54.2	67.6	63.9	49.7
> 0.5 min. wage	64.4	64.2	67.0	49.6

Total

Gender
Female	63.7*	62.8*	67.9*	48.2*
Male	67.9*	68.7*	70.3*	52.2*
Age group
≤ 40 y.o.	68.1*	64.9	70.2*	48.8
> 40 y.o.	62.7*	63.9	67.4*	49.3
Education level
≤ 4^th grade	61.9*	61.4*	68.3	48.1*
> 4^th grade	66.3*	65.7*	68.6	49.6*
Per capita family income
≤ 0.5 min. wage	62.7	63.8	63.3	48.1
> 0.5 min. wage	65.0	64.4	68.9	49.2

Quality of life’s domains	Psychic distress
Rio de Janeiro (N = 909)	CMD3 (*)		CMD5		Anxiety		Depression
Rio de Janeiro (N = 909)	Yes	No	Yes	No	Yes	No	Yes	No

Physical	63.9	65.8	54.1	70.5	56.1	70.6	55.1	68.9
Psychological	64.2	64.7	52.3	70.2	54.1	70.4	51.0	69.2
Social relations	68.7	70.0	62.1	73.2	63.9	72.9	63.1	71.9
Environment	48.6	49.0	42.0	52.0	43.4	52.0	41.4	51.4

São Paulo (N = 557)	*CMD3 ()**		CMD5		Anxiety		Depression
São Paulo (N = 557)	Yes	No	Yes	No	Yes	No	Yes	No

Physical	63.1	63.6	50.3	70.2	53.9	69.8	49.1	68.4
Psychological	65.4	63.3	51.9	69.7	54.4	69.9	48.0	69.1
Social relations	70.0	66.4	56.9	71.3	58.5	71.7	55.8	70.1
Environment	48.0	50.0	43.0	52.7	43.5	53.3	40.4	52.5

Total	*CMD3 ()**		CMD5		Anxiety		Depression
Total	Yes	No	Yes	No	Yes	No	Yes	No

Physical	63.6	65.5	52.6	70.4	55.2	70.3	52.8	68.7
Psychological	64.7	64.2	52.1	70.0	54.2	70.2	49.8	69.1
Social relations	68.1	68.6	60.0	72.5	61.7	72.5	60.3	71.2
Environment	48.4	49.3	42.4	52.3	43.4	52.5	41.0	51.8

Socioeconomic characteristics	Quality of life

	Physical	Psychological	Social relations	Environment
CMD3
Gender
Female	63.2	63.6*	68.2	47.7
Male	65.2	68.9*	67.8	51.0
Age group
≤ 40 y.o.	66.4*	65.8	68	47.8
> 40 y.o.	62.0*	64	68.1	48.7
Education level
≤ 4^th grade	61.1*	62.1*	69.8	48.1
> 4^th grade	65.0*	66.1*	67.1	48.5
Per capita family income
≤ 0.5 min. wage	52.4	68.1	68.1	43.2
> 0.5 min. wage	64.1	64.5	67.8	48.2
CMD5
Gender
Female	53.0	52.0	60.5	42.3
Male	50.0	52.5	56.9	43.0
Age group
≤ 40 y.o.	57.9*	53.5	62.2*	43.1
> 40 y.o.	49.4*	51.2	58.6*	42.0
Education level
≤ 4^th grade	51.2	52.0	61.9	43.1
> 4^th grade	53.5	52.2	58.9	42.0
Per capita family income
≤ 0.5 min. wage	56.3	52.2	50.4*	41.2
> 0.5 min. wage	52.6	52.0	60.6*	42.5
ANXIETY
Gender
Female	54.5*	53.2*	61.9	43.1
Male	58.4*	59.1*	60.4	45.0
Age group
≤ 40 y.o.	59.5*	56.1*	63.0	43.8
> 40 y.o.	52.5*	53.0*	60.9	43.2
Education level
≤ 4^th grade	59.5*	56.1	63.0*	43.8
> 4^th grade	52.5*	53.0	60.9*	43.2
Per capita family income
≤ 0.5 min. wage	59.0	59.6	59.1	45.0
> 0.5 min. wage	55.3	53.9	61.8	43.2
DEPRESSION
Gender
Female	52.6	49.1*	60.6	40.8
Male	53.7	54.0*	58.7	42.5
Age group
≤ 40 y.o.	58.0*	52.5*	62.1	41.1
> 40 y.o.	49.9*	48.3*	59.3	41.0
Education level
≤ 4^thgrade	51.3	48.0	64.4*	42.5
> 4^th grade	53.7	50.9	57.9*	40.2
Per capita family income
≤ 0.5 min. wage	58.2	53.3	55.8	46.6
> 0.5 min. wage	52.8	49.7	60.8	41.0

[1] Correspondence address to: Flávia Batista Portugal Rua Manoel Barros da Costa, 61, ap. 501, Jardim Camburi 29090-730 – Vitória, ES, Brazil Email: flaviabportugal@gmail.com

Brasil

Brasil

Psychiatric morbidity and quality of life of primary care attenders in two cities in Brazil

Sofrimento psíquico e qualidade de vida em pacientes da atenção primária de duas cidades do Brasil

Objective:

Methods:

Results:

Conclusion: