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SMAD. Revista eletrônica saúde mental álcool e drogas

On-line version ISSN 1806-6976

SMAD, Rev. Eletrônica Saúde Mental Álcool Drog. (Ed. port.) vol.14 no.1 Ribeirão Preto Jan./Mar. 2018

http://dx.doi.org/10.11606/issn.1806-6976.smad.2018.000404 

ORIGINAL ARTICLE
DOI: 10.11606/issn.1806-6976.smad.2018.000404

 

Minor psychiatric disorders in users of psychoactive substances

 

Trastornos psiquiátricos en usuarios de sustancias psicoactivas

 

 

Karine Langmantel SilveiraI; Michele Mandagará de OliveiraI; Poliana Farias AlvesI

IUniversidade Federal de Pelotas, Pelotas, RS, Brazil

 

 


ABSTRACT

OBJECTIVE: To verify the prevalence of Minor Psychiatric Disorders according to the demographic and socioeconomic profile, type of drug used and the health conditions of users of crack, alcohol and other drugs.
METHODOLOGY: Cross-sectional study, with a sample of 505 users. The Self-Reporting Questionnaire was used to verify the prevalence of disorders.
RESULTS: The prevalence found was 28.7%, higher among crack users, women, blacks, divorcees or widowers, unemployed, users with health problems, poor self-assessment of health and who are dissatisfied with family relationships.
CONCLUSIONS: The presence of Minor Psychiatric Disorders may be related to some factors that include not only individual characteristics, but also social, cultural and economic issues, among others.

Descriptors: Substance-Related Disorders; Drug Users; Minor Psychiatric Disorders.


RESUMEN

OBJETIVO: verificar la prevalencia de Trastornos Psiquiátricos Menores de acuerdo con el perfil demográfico y socioeconómico, con el tipo de droga utilizada y con las condiciones de salud de los usuarios de crack, alcohol, y otras drogas.
METODOLOGÍA: estudio transversal, con amuestra de 505 usuarios. Se utilizó el Self-Reporting Questionnaire para verificación de prevalencia de los trastornos.
RESULTADOS: la prevalencia encontrada fue de 28,7%, siendo superior entre usuarios de crack, mujeres, negros, divorciados o viudos, desempleados, entrevistados con problemas de salud, mala autoevaluación de salud, y que están insatisfechos con relacionamientos familiares.
CONCLUSIÓN: constatado que la presencia de los trastornos psiquiátricos menores puede estar relacionada con algunos factores que incluyen no solamente las características individuales, pero también cuestiones sociales, culturales, económicas, entre otras.

Descriptores: Trastornos Relacionados con Sustancias; Consumidores de Drogas; Trastornos Psiquiátricos Menores.


 

 

Introduction

Minor psychiatric disorders (MPD) refer to the health status of individuals with symptoms of depression, anxiety or somatic symptoms; however, there are no criteria for the diagnosis of such disorders according to the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition) and the ICD-10 (International Classification of Diseases - 10th Revision)(1). Regarding the prevalence of these disorders worldwide, it is estimated that 4.4% of the global population suffers from depressive disorders and 3.6% from anxiety disorders. This prevalence varies depending on the region, with the highest rates of depression in the African Region (5.4%) and anxiety disorders in the Americas (5.8%)(2).

Most individuals with MPD present complaints such as sadness, anxiety, tiredness, decreased concentration, somatic problems, irritability and insomnia. These minor morbidities can also be named as common mental disorders, a term that reinforces the frequent character of these disorders(3). This type of complaint is one of the recurring demands in Primary Health Care, however, it often does not receive proper attention and treatment(4). The literature indicates that users with MPD may present functional losses and impairments that are comparable or more severe than people with chronic disorders, with impact on economic, social and living standards of people and families(5).

For the detection of MPD, the Self-Reporting Questionnaire (SRQ-20) was created in 1980, which suggests a level of suspicion (presence/absence) of some mental disorder. It evaluates whether there is any disorder, but does not offer specificity of the type of existing disorder. Due to this screening character, this questionnaire is quite adequate for population studies, being very useful for a first classification of possible cases and non-cases(6).

According to the WHO, the social context of people and groups can significantly influence the emergence of mental health problems, such as MPD. Families living in poverty, minority groups, people with chronic health problems, people suffering from discrimination and human rights violations, neglected children and people exposed to the abuse of psychoactive substances (PAS) are the main vulnerable groups(7).

In a more challenging framework, MPD may be associated with the abusive use of PAS. This comorbidity may be an aggravating factor, inducing and perpetuating the condition of substance dependence or abuse. It also may interfere in the quality of life of the user of psychoactive substances, thus justifying a greater need for investigating this phenomenon(8-9).

Thus, this study aimed to verify the prevalence of Minor Psychiatric Disorders according to the demographic and socioeconomic profile, the type of psychoactive substance used and the health conditions of users of crack, alcohol and other drugs in the city of Pelotas-RS.

 

Methodology

This is a cross-sectional and exploratory study that integrates the research "Profile of Crack Users and Patterns of Use", funded by the National Council for Scientific and Technological Development (CNPq), notice MCT/CNPq No. 041/2010.

The research was developed in a city in the interior of the state of Rio Grande do Sul that has two distinct services aimed at the psychosocial care of people who use crack, alcohol and other drugs. The prevalence of drug users was unknown (p = 0.50), a sampling error of 4% (d = 0.04) was admitted, under a 95% confidence level (α = 0.05), and the number of participants in each stratum was proportional to the total number of registered users. The final sample consisted of 505 users. The systematic selection of respondents was the direct random draw in the databases of the two services.

For the present study, the adapted SRQ score was adopted as dependent variable and the independent variables were demographic and socioeconomic profile, the type of drug that the interviewee had already used in life, whether he/she has a health problem, self-assessment of health and family relationships).

The SRQ is a questionnaire that contributes to the identification of psychiatric disorders in primary care. It was created in four developing countries (Colombia, Sudan, India and the Philippines) and validated in Brazil in 1986(10). It consists of 20 questions designed to screen "neurotic" disorders. For a person to be considered as a possible case, one must reach a score of eight or more affirmative responses in the subscale of "neurotic" symptoms for women and six or more affirmative responses for men. This was obtained earlier by determining the sensitivity, specificity and positive and negative predictive values in other samples(11).

Initially, during the pilot test, we used the SRQ scale with 20 questions, but to facilitate the comprehension of the users, the participants requested to group four questions into two, since they addressed similar content, so the SRQ was used with 18 questions. In order to validate the internal consistency of the responses, the Cronbach’s Alpha Coefficient was applied, in which the results of the present study remained within the limit of 0.7 to 0.9, representing a good internal consistency(12), as observed in Table 1.

 

 

The questionnaires were coded by the interviewer and reviewed by the coordinators. The data was entered through the Microsoft Access 2003 database manager.

Data analysis was performed using the STATA 12 software and consisted in describing the absolute and relative frequencies of the demographic and socioeconomic characteristics of the entire sample, stratified according to SRQ score (positive or negative). Distributions of bivariate frequencies and descriptive measures (means and standard deviation) were used. The bivariate analyzes were performed with the purpose of describing and verifying proportional differences between the stratification groups through the Pearson Chi-square tests for the nominal variables and the Chi-square of Linear Tendency for the ordinal variables. The Student’s t-test was applied to verify differences between the average SRQ score of users (of crack and other drugs). The level of significance adopted in all tests was 5% (p ≤ 0.05).

The research complied with the ethical principles of Resolution COFEN No. 311/2007 and Resolutions 196/96 and 466/12 of the National Health Council of the Ministry of Health. The project was approved by the Ethics and Research Committee of the Faculty of Nursing of the Federal University of Pelotas under opinion no. 301/2011.

 

Results

The study population consisted of 505 users of PAS. The demographic profile of the interviewees was predominantly males (83.8%), with white self-reported skin color (50.9%); more than half of the interviewees were single (53.3%). The mean age was 38 ± 13.1 years, with a minimum of 18 and a maximum of 76 years. The socioeconomic profile revealed individuals with low educational level, in which 77.8% had only complete or incomplete elementary education. Regarding family income, 26% had no income or income was less than one minimum wage (MW). Regarding the occupational status, 29.1% were unemployed and only 23.4% had a formal employment relationship.

Regarding the prevalence of MPD in the sample, 28.7% of the interviewees had positive screening on the SRQ scale. Table 2 shows the demographic and socioeconomic characteristics of drug users, stratified according to the SRQ score.

There is a direct relationship between SRQ score and age, and increased frequency of individuals with a positive screening for MPD between the ages of 30 and 39 years. However, these proportional trends were not statistically significant between groups.

There were statistically significant proportional differences between the groups with respect to color (p = 0.029). The study population was predominantly white; however, the relationship between skin color and the SRQ score shows predominance of black users with MPD in this group.

There were also statistically significant proportional differences between the SRQ score and the marital status (p = 0.008). The highest prevalence of MPD was in the group of people who declared to be divorced/widowed/separated.

There were no statistically significant proportional trends between the groups and schooling.

There were statistically significant proportional trends between the economic activity status and the SRQ score (p = 0.02), with a higher prevalence of MPD among users who said they have not been working.

Despite the predominance of males among the interviewed users (83.8%), the prevalence of MPD was higher among women (32.9%), which deserved to be highlighted in the analysis.

Figure 1 shows the distribution of the SRQ score with stratification by sex and type of PAS used.

Of the 505 interviewed users, drug users (except crack) were the predominant group, with 369 respondents (73.1%), and those who reported using crack were 136 users (26.9%). However, Figure 1 shows that the SRQ score was higher among crack users. In both groups, females showed a greater dispersion and higher concentration of values above the median value of the sample (md = 3, mean = 4.1 and standard deviation = 3.7). Males presented lower median value of SRQ scores in both groups.

 

 

In relation to the types of PAS that has been used at least once in life by the users, the most frequently mentioned were alcohol (96.1%), tobacco (81.4%), marijuana (52.4%), cocaine (40.2%) and crack (26.7%). Table 3 shows the SRQ score distribution according to these substances.

When we verified the association between the drugs used and the SRQ score, it was observed that users who reported having used crack at least once in their life had a prevalence of PMD nearly twice higher than the study population (28.7% vs. 43%), followed by cocaine users (28.7% vs 37.7%). Participants who reported having used these two types of PAS had statistically significant proportional differences regarding SRQ score (p <0.05).

After verifying the variance of the SRQ score among users (of crack and other drugs), it was found through the Student’s t test that there is statistically significant evidence that the mean SRQ score differs between users (p <0.001).

Table 4 shows the association between the SRQ score and the characteristics related to the health status and to the family relationship between users.

Regarding the health status of the users, there was a higher prevalence of MPD among those who reported having health problems (42.9%), given that there were statistically significant proportional differences (p <0.001).

There was a direct relationship with statistically significant proportional tendencies in the pattern of answers of health perception and the increased prevalence of MPD, in which those with the worst assessment of health presented a higher prevalence (p <0.001).

The relationship with family and the SRQ score reveal that users dissatisfied with their relationships present more prevalence of MPD when compared to those who are satisfied, being this a statistically significant result (p = 0.009).

 

Discussion

Research shows that MPD can affect people from all regions of the world; however, the prevalence of these disorders has shown to be higher in specific population groups, which include the abusive users of PAS(2,7,14-16).

The present study revealed that the prevalence of MPD in the users of PAS was 28.7%, a result that is lower than that observed in a study conducted with PAS users in the state of Goiás (37.3%)(15). However, when considering only those participants users who reported having used crack at least once in life, they had a higher propensity to develop MPD than the other PAS users. This result is in agreement with the literature when it points out that crack users present a higher occurrence of depressive and anxious symptoms than users of other substances(17).

The occurrence of MPDs may be related to some determinants that predict the onset of mental health disorders, which include not only individual characteristics, but also social, cultural, economic, political and environmental factors(2). Thus, this shows that the biopsychosocial vulnerability of most PAS users could justify a higher prevalence.

In this study, the self-reported black color (36.9%), being divorced, widowed or separated (40.9%) and not being working at the time the interview took place (37.4%) were the individual characteristics that has statistically significant relation with positive screening for MPD. However, the gender variable, even without statistically significant differences, deserves to be highlighted, since although the majority of the interviewees were male, the prevalence of MPD was higher among women (32.8%). These results are in agreement with the literature, in which a higher prevalence of disorders was observed in most of these groups both in studies with PAS users and in population-based studies(4,15,17-18).

It was also verified the influence of the health status and family relationship in the variation of prevalence of MPDs. Participants who reported having a health problem, self-rated their health as very poor and stated they were dissatisfied with the family relationships were those who presented the highest prevalence of MPD compared with those who reported having no health problem, who self-rated their health as good, very good or regular, and who have stated to be satisfied with family relationships.

These results show that the presence of psychic symptoms, such as anxiety and depression associated with PAS abuse, is frequent, emphasizing that the comorbidity MPD could increase the severity of PAS-related symptoms, as well as influence in several areas of the user’s life, thus making it necessary to correctly identify them.

However, because this is a cross-sectional study, it cannot be confirmed whether the use of PAS leads to the presence of MPD or whether it is the presence of these disorders that influence the use of the substance. In any case, it is known that a social context of vulnerability can interfere both in the onset of MPD and in the use of PAS. In this way, there is the need for more in-depth knowledge about social factors of vulnerability in order to think and act more decisively to reduce social inequities. Obviously, a study focused on this goal could effectively raise health care that is based only on biological aspects to a higher level of biopsychosocial care.

 

Conclusion

The present study showed that the presence of the Minor Psychiatric Disorders can be related to some factors that include not only the individual characteristics, but also social, cultural and economic aspects, among others. Therefore, there is the need of a network of care to users of PAS in which the health professionals are attentive to the other, trying to identify their desires and needs, and for this purpose, the professional’s look must go beyond the reason that led users to seek the health service. By adopting this behavior at the moment of care, the professional assumes that health and illness are not only objects, rather, they are the way of being and leading life.

 

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Received: July 19th 2017
Accepted: July 31st 2018

Corresponding author:
Karine Langmantel Silveira
E-mail: kaa_langmantel@hotmail.com
 https://orcid.org/0000-0002-2598-5278

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