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

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Jornal Brasileiro de Psiquiatria

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Original articles • J. bras. psiquiatr. 63 (1) • Jan-Mar 2014 • https://doi.org/10.1590/0047-2085000000004 copy

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

About the authors

Objective:

To identify the associations among quality of life (QoL), social determinants and psychological distress in primary care in two cities in Brazil.

Methods:

A cross-sectional study with 1,466 patients from 2009 to 2010. The statistical analysis used the t-test to compare the variables of interest to the study.

Results:

The prevalence of Common Mental Disorders (CMD3), severe forms of Common Mental Disorders (CMD5), anxiety and depression were 20.5%, 32%, 37% and 25.1% respectively. Thes presence of psychological distress is associated with worse QoL among the patients studied, especially those older than 40 years of age. In cases of CMD3, those with higher income and educational levels presented higher QoL in the psychical and psychological domains. For the cases of probable anxiety, those with higher educational levels presented lower scores on the physical and social relationship scores.

Conclusion:

Psychological distress can be associated with a worse QoL among those studied and can be influenced by socioeconomic conditions. Therefore, it is important to structure patient-centered help, which should also include patients’ social contexts.

Mental health; primary health care; quality of life; mental disorders; socioeconomic factors


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

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[TFN01t01] Note 1: min. wage = national minimum wage of the reference year (2009 in Rio de Janeiro and São Paulo).

[TFN02t01] Note 2: in bold are the results in which p-value < 5% in the chi-square test.