A study published in the Journal of Psychiatric Research reveals that in the metropolitan region of São Paulo, 1.6% of the population says they have suffered from post-traumatic stress in the last 12 months and 3.2% have already experienced the problem throughout their lives. Although the results indicate a low prevalence of the disorder, they draw attention to the large number of subsyndromal cases, that is, those in which the person does not present all the symptoms that configure the disorder, but is on the threshold.
“The concept of post-traumatic disorder was developed based on cases of war, in which individuals had very serious symptoms. Brazil is a very violent country, but it is not experiencing a civil war. United, we have a low prevalence. However, we observe many cases that are called subsyndromal and that deserve attention”, explains Wang Yuan Pang, researcher at the Institute of Psychiatry of the Faculty of Medicine of the University of São Paulo (FM-USP), who coordinated the survey. According to Wang, the rate of exposure to traumatic events was high, in some cases exceeding 35% of the sample.
The study was supported by FAPESP and was the first to evaluate the metropolitan region in a systematic way, with a representative sample of the population. In all, 5,037 adult volunteers were included. The initiative is part of a larger survey, entitled The São Paulo Megacity Mental Health Survey, conducted within the scope of the international consortium World Mental Health (WMH), coordinated by WHO (World Health Organization) and Harvard University (USA), with more than 20 participating countries.
Wang explains that post-traumatic stress disorder is a mental health condition triggered by a terrifying event, which may have been experienced or just witnessed. “The first criterion is that the person is a victim of trauma and only time can distinguish between acute and chronic stress, which persists for more than six months. Post-traumatic stress disorder consists of various symptoms, such as nightmares , severe anxiety, sudden memories of the traumatic scene [flashbacks]. In addition, it is common for the person to avoid some behaviors to escape situations that bring some memory of the traumatic event, “he explains.
According to the researcher, the intensity and frequency of these symptoms are also relevant aspects. “These are people who are very jumpy, who have exaggerated reactions to various stimuli and with anxiety and subsequent depression. These symptoms are felt every day. It is a highly dysfunctional problem, the person is unable to work and lead a minimally satisfactory life. It is worth mentioning that subsyndromal cases can also be dysfunctional”, he says.
Similar studies done in other developing countries indicated a lower prevalence of post-traumatic stress (lifetime): 0.7% in Peru, 1.5% in Mexico, and 1.8% in Colombia—with Medellín, which was considered one of the most violent cities in the world in the 1980s and 1990s, the index jumps to 3.7%.
On the African continent, where large-scale population studies are scarce, the prevalence of this disorder in the sample was almost zero. In South Africa, lifetime prevalence was 2.3%, and last 12 months, 0.7%.
triggers
Among the most reported traumas in the Brazilian study are the act of witnessing someone being injured or killed or seeing a dead body unexpectedly (35.7%) and being robbed or threatened with a weapon (34%).
The most common events for subsyndromal cases were “sudden and unexpected death of a loved one” (34%), “interpersonal violence” (31%) and “threats to the physical integrity of other people” (25%).
The study showed that experiences related to interpersonal violence were more likely to develop post-traumatic stress disorder. Thus, events such as being sexually assaulted or molested (21.2% in total, with virtually all cases among women) and being raped (18.8% in total; 18.4% for women and 20.1% for men) were the two experiences most likely to trigger post-traumatic stress disorder.
“It is possible that some groups of people have a greater chance of developing the disorder than others. With the results of the study, we can observe, for example, that there is an important focus on gender. Brazil is a violent country with a high rate of domestic violence, especially against women, who are more likely to develop post-traumatic stress disorder after exposure to these events”, said Bruno Mendonça Coêlho, researcher at the Institute of Psychiatry and first author of the study.
proper treatment
Wang points out that, in terms of public health, post-traumatic stress disorder has a much lower prevalence than that of anxiety, panic, social anxiety or depression —conditions that together affect almost 20% of the population. However, according to the researcher, it is important that future studies seek to identify where people suffering from post-traumatic stress are, so that they receive adequate care.
In previous works, the researcher verified access to mental health in the metropolitan region of São Paulo, including all disorders.
“Taking into account the very serious cases of depression, panic, anxiety and other disorders, we estimate that approximately 1 million people in the metropolitan region of São Paulo need specialized treatment. However, only 10% of the very serious patients were able to receive some type of treatment. service, either in the public service or in the private sector. This shows that there is a huge gap in assistance”, he says.