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. The data are from the study Correlation and Prevalence of Post-traumatic Stress Disorders in the Metropolitan Region of São Paulo, which were published in the December edition of the Journal of Psychiatric Research.
Post-traumatic stress disorder (PTSD) is a mental health condition that is triggered after a person goes through, or even witnesses, a traumatic event, explains researcher at the Institute of Psychiatry and first author of the study, Bruno Mendonça Coelho, psychiatrist and Doctor of Science.
“After such [de trauma] the individual develops a series of long-lasting physical and psychological reactions that generate intense suffering. Symptoms include intense distress and anxiety, nightmares, flashbacks, dysfunctional thoughts, and other symptoms.”
The results of the study indicate a low prevalence of the disorder, however, the researchers warn of 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 presence of a psychiatric disorder in a person is determined from a set of signs and symptoms. We collect such signs and symptoms and, from a certain number of them, we consider that the person has the disease. In those who have a number of symptoms below this ‘threshold’ that the manual considers a disease, the presence of intense symptoms can be a source of great suffering. Therefore, we have to pay attention to them, as they have a higher risk both of developing PTSD and have a higher risk of other disorders”, warns Coelho.
The study was supported by the State of São Paulo Research Foundation (FAPESP) and was the first to evaluate the Metropolitan Region systematically, with a representative sample of the population. In all, 5,037 adult volunteers were interviewed. The initiative is part of a larger survey, entitled The São Paulo Megacity Mental Health Survey (Research on mental health in greater São Paulo), conducted within the scope of the international consortium World Mental Health (WMH), coordinated by the World Health Organization and Harvard University, in the United States, with more than 20 participating countries.
For Coelho, the data are alarming. “Although we know that Brazil is a violent country, having the data in hand is still surprising. It is also difficult to realize that we live in a society where almost a third of the population of the metropolitan region of São Paulo has already experienced some type of interpersonal violence. This is alarming! Despite this (and the cases that fall below the threshold for diagnosis), it is heartening to realize that most people survive this type of situation without major damage”.
Symptoms and trauma
The intensity and frequency of PTSD symptoms are also relevant aspects, adds Wang Yuan Pang, a researcher at the Institute of Psychiatry at the Faculty of Medicine of the University of São Paulo (FM-USP), who coordinated the survey.
“These are people who are very jumpy, who have overreactions to various stimuli and with subsequent anxiety and depression. These symptoms are felt every day. It is a highly dysfunctional problem, the person cannot work and lead a minimally satisfactory life. It is worth noting that subsyndromal cases can also be dysfunctional, ”he says.
The study shows that the most reported traumas are related to 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%). According to the study, 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 also showed that experiences related to interpersonal violence were more likely to develop post-traumatic stress disorder. Events such as being sexually assaulted or molested (21.2% overall) and being raped (18.8% overall; 18.4% for women and 20.1% for men) were the two experiences most likely to trigger a picture of post-traumatic stress.
“It is possible that some groups of people are more likely to develop 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 Coelho.
In addition to social factors, for women there is also the biological factor, says Coelho. “But there is also, in women, a greater biological vulnerability to general anxiety disorders and depression.”
Public policy
Wang points out that, in terms of public health, post-traumatic stress disorder has a much lower prevalence than anxiety, panic, social anxiety or depression.
“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 very serious patients were able to receive some type of care, whether in the public service or in the private sector”.
The researcher emphasizes the importance of updated data for the construction of public policies: “It is important that future studies there are people who suffer from post-traumatic stress, so that they receive adequate care”, says Wang, based on previous works, in which access to mental health in the Metropolitan Region of São Paulo was verified.
Coelho states that the treatment of cases involves psychotherapy, “mainly cognitive-behavioral psychotherapies and psychiatric medications”, he concluded.